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Red Cell Distribution Width is Associated with Bleeding Complications after Coronary Artery Bypass Grafting

Alexandra Aldis Heimisdottir1,2, Luis Gisli Rabelo1,2, Matthildur Maria Magnusdottir2

  • 1Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, 101, Iceland.

Interdisciplinary Cardiovascular and Thoracic Surgery
|December 22, 2025
PubMed

Insights

Elevated red cell distribution width (RDW) predicts increased bleeding complications after coronary artery bypass grafting (CABG). This simple biomarker can improve preoperative risk assessment for CABG patients.

Area of Science:

  • Cardiovascular Surgery
  • Hematology
  • Clinical Pathology

Background:

  • Elevated red cell distribution width (RDW) is linked to adverse outcomes in coronary artery disease.
  • The predictive value of RDW for bleeding after cardiac surgery remains unclear.

Purpose of the Study:

  • To evaluate if preoperative RDW predicts bleeding complications following isolated coronary artery bypass grafting (CABG).

Main Methods:

  • Nationwide retrospective study of 1,929 patients undergoing isolated CABG (2003-2019).
  • RDW analyzed continuously and dichotomously (>14.0% vs <=14.0%).
  • Primary bleeding outcomes: >4 RBC units transfused, re-exploration for bleeding, or >1000 mL/24h chest tube output. Multivariable logistic regression was used for analysis.

Main Results:

  • Higher RDW was associated with older age, anemia, comorbidities, and urgent procedures.
  • Adjusted analysis showed elevated RDW predicted increased transfusion (OR 1.72 for >14.0%), re-exploration (OR 2.39 for >14.0%), and chest tube output (OR 1.34 for >14.0%).
  • RDW also correlated with greater platelet/plasma use, longer ICU stay, and major complications, but not 30-day mortality.

Conclusions:

  • Preoperative elevated RDW is an independent predictor of multiple bleeding complications after CABG.
  • RDW offers a simple, cost-effective biomarker for enhancing preoperative bleeding risk stratification in CABG patients.
Abstract

Keywords:
CABGRDWbleedingperioperative morbidityre-explorationtransfusion

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