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Published on: August 2, 2019
Cryoprecipitate Transfusion After Cardiac Surgery
Jake V Hinton1, Zhongyue Xing1, Calvin M Fletcher2
1Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Insights
Postoperative cryoprecipitate transfusion in cardiac surgery patients was not linked to worse outcomes, even in sicker individuals. Further research is needed to confirm safety and usage patterns in this patient group.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- The role of cryoprecipitate transfusion in cardiac surgery outcomes remains unclear.
- Understanding predictors and outcomes of cryoprecipitate use is crucial for patient management.
Purpose of the Study:
- To investigate predictors of postoperative cryoprecipitate transfusion in cardiac surgery patients.
- To determine the association between cryoprecipitate transfusion and patient outcomes.
Main Methods:
- Utilized the Medical Information Mart for Intensive Care III and IV databases.
- Included adult patients undergoing cardiac surgery, employing propensity score matching for cryoprecipitate-treated patients and controls.
- Assessed in-hospital mortality, infection, acute kidney injury, and length of stay as primary and secondary outcomes.
Main Results:
- 2.35% of 12,043 eligible patients received cryoprecipitate post-cardiac surgery.
- Propensity score matching identified 195 cryoprecipitate recipients and 743 controls.
- Cryoprecipitate transfusion was not significantly associated with in-hospital mortality, infection, or acute kidney injury.
Conclusions:
- Cryoprecipitate was administered to sicker patients with increased bleeding, but its use did not correlate with adverse outcomes.
- Larger, multicenter studies are recommended to further clarify the safety and utilization of cryoprecipitate in cardiac surgery.
Objectives:
The association of cryoprecipitate transfusion with patient outcomes after cardiac surgery is unclear. We aimed to investigate the predictors of, and outcomes associated with, postoperative cryoprecipitate transfusion in cardiac surgery patients.
Methods:
We used the Medical Information Mart for Intensive Care III and IV databases. We included adults undergoing cardiac surgery, and propensity score matched cryoprecipitate-treated patients to controls. Using the matched cohort, we investigated the association of cryoprecipitate use with clinical outcomes. The primary outcome was in-hospital mortality. Secondary outcomes were infection, acute kidney injury, intensive care unit length of stay, hospital length of stay, and chest tube output at 2-hour intervals.
Results:
Of 12,043 eligible patients, 283 (2.35%) patients received cryoprecipitate. The median dose was 5.83 units (IQR 4.17-7.24) given at a median first transfusion time of 1.75 hours (IQR 0.73-4.46) after intensive care unit admission. After propensity scoring, we matched 195 cryoprecipitate recipients to 743 controls. Postoperative cryoprecipitate transfusion was not significantly associated with in-hospital mortality (odds ratio [OR] 1.10; 99% confidence interval [CI] 0.43-2.84; p=0.791), infection (OR 0.77; 99% CI 0.45-1.34; p=0.220), acute kidney injury (OR 1.03; 99% CI 0.65-1.62; p=0.876) or cumulative chest tube output (adjusted mean difference 8 hrs post transfusion, 11 mL; 99% CI -104 to 125; p=0.804).
Conclusions:
Although cryoprecipitate was typically given to sicker patients with more bleeding, its administration was not associated with worse outcomes. Large, multicentred studies are warranted to further elucidate cryoprecipitate's safety profile and patterns of use in cardiac surgery.
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