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Albumin Infusion and Blood Loss After Cardiac Surgery.
Akseli Talvasto1, Minna Ilmakunnas1, Peter Raivio2
1Department of Anesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
The Annals of Thoracic Surgery
|April 29, 2023
Summary
Four percent albumin increased bleeding during cardiac surgery compared to Ringer acetate. This albumin-related bleeding risk was higher with complex or urgent procedures and preoperative aspirin use.
Area of Science:
- Cardiovascular Surgery
- Anesthesiology
- Pharmacology
Background:
- The ALBICS trial indicated 4% albumin increases perioperative bleeding in cardiac surgery.
- This study further characterizes albumin-associated bleeding risks.
Purpose of the Study:
- To explore the factors contributing to increased bleeding associated with 4% albumin use in cardiac surgery.
- To compare bleeding events between 4% albumin and Ringer acetate in adult cardiac surgery patients.
Main Methods:
- A randomized, double-blinded comparison of 4% albumin and Ringer acetate in 1386 adult on-pump cardiac surgery patients.
- Bleeding was assessed using the Universal Definition of Perioperative Bleeding (UDPB) criteria.
Main Results:
- Higher UDPB bleeding grades were observed in the albumin group compared to the Ringer group (P < .001).
- Albumin use was associated with increased requirements for red blood cells (OR 1.80), platelets (OR 1.79), and fibrinogen (OR 2.24).
- Albumin group allocation (OR 2.18), complex surgery (OR 2.61), and urgent surgery (OR 1.63) were strong predictors of bleeding. Albumin's effect was amplified by preoperative aspirin.
Conclusions:
- Perioperative 4% albumin administration significantly increased blood loss and UDPB bleeding class compared to Ringer acetate.
- The magnitude of albumin-induced bleeding risk was comparable to surgical complexity and urgency.
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