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Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction

Hooman Kamel1, S Claiborne Johnston, John C Kirkham

  • 1Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, NY 10065, USA. hok9010@med.cornell.edu

Circulation
|June 9, 2012
PubMed

Insights

Major bleeding during surgery significantly increases the risk of stroke and heart attack in patients. This finding highlights the need for further research into managing bleeding and vascular events in surgical settings.

Area of Science:

  • Perioperative Medicine
  • Vascular Surgery
  • Critical Care Medicine

Background:

  • Hemorrhage is a known risk factor for ischemic complications in cardiac patients.
  • The relationship between perioperative hemorrhage and ischemic events in general surgical patients remains unclear.

Purpose of the Study:

  • To investigate the association between major perioperative hemorrhage and the incidence of stroke or myocardial infarction in adult surgical patients.
  • To determine if major bleeding during non-cardiac, non-neurological surgery independently predicts subsequent vascular events.

Main Methods:

  • Analysis of data from the National Surgical Quality Improvement Program (2005-2009).
  • Inclusion of adult patients undergoing non-emergent, non-trauma, non-transplant, non-cardiac, and non-neurological surgery.
  • Definition of major hemorrhage as >4 units of packed red blood cells or whole blood transfusion; stroke as vascular cause lasting ≥24 hours; myocardial infarction as new ECG Q waves.
  • Cox proportional hazards models used to control for covariates and assess independent associations.

Main Results:

  • Out of 651,775 patients, 0.80% experienced major hemorrhage, 0.24% had Q-wave myocardial infarction, and 0.20% suffered a stroke.
  • Major perioperative hemorrhage was independently associated with a 2.5-fold increased risk of stroke (HR 2.5, 95% CI 1.9-3.3).
  • Major perioperative hemorrhage was independently associated with a 2.7-fold increased risk of Q-wave myocardial infarction (HR 2.7, 95% CI 2.1-3.4).

Conclusions:

  • Major perioperative hemorrhage is a significant independent predictor of subsequent stroke and myocardial infarction in patients undergoing non-cardiac, non-neurological surgery.
  • The findings suggest a potential need for randomized trials to evaluate perioperative strategies, such as antiplatelet drug use, to mitigate risks of both bleeding and vascular events.
Abstract

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