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Perioperative Plasma in Addition to Red Blood Cell Transfusions Is Associated With Increased Venous Thromboembolism
Una E Choi1, Ryan C Nicholson1, Steven M Frank1
1From the Departments of Anesthesiology and Critical Care Medicine.
Anesthesia and Analgesia
|February 28, 2024
Summary
Adding plasma to red blood cell (RBC) transfusions increases the risk of mortality and serious complications like venous thromboembolism (VTE), pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) in surgical patients.
Area of Science:
- Transfusion Medicine
- Surgical Outcomes
- Patient Blood Management
Background:
- Perioperative red blood cell (RBC) transfusions are linked to increased venous thromboembolic (VTE) events.
- The specific risk of additional perioperative plasma, beyond RBCs, on VTE is not well-established.
Purpose of the Study:
- To investigate the association between perioperative plasma and RBC transfusions versus RBC-only transfusions with postoperative outcomes.
- To evaluate the risk of mortality, VTE, pulmonary embolism (PE), and disseminated intravascular coagulation (DIC) in surgical patients receiving additional plasma.
Main Methods:
- A retrospective analysis of a US claims and electronic health record database (TriNetX Diamond Network).
- Comparison of surgical patients receiving perioperative plasma and RBCs versus those receiving RBCs alone.
- Propensity score matching was used to control for patient characteristics and surgery type in analyses of all surgeries and cardiovascular surgeries.
Main Results:
- Patients receiving plasma + RBC had a higher risk of 30-day mortality (RR: 1.36), VTE (RR: 1.36), PE (RR: 1.46), and DIC (RR: 2.75) compared to RBC-only transfusion.
- These increased risks were also observed in the subgroup of cardiovascular surgery patients.
Conclusions:
- Adding plasma to perioperative RBC transfusions is associated with increased risks of mortality, VTE, PE, and DIC.
- Reducing unnecessary plasma transfusions is crucial for patient blood management and improving healthcare value.
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