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Frequency, predictors, and appropriateness of blood transfusion after percutaneous coronary interventions
M Moscucci1, M Ricciardi, K A Eagle
1Heart Care Program, University of Michigan Medical Center, Ann Arbor 48109-0022, USA.
Insights
Many blood transfusions after percutaneous coronary interventions are unnecessary. Following guidelines can reduce inappropriate transfusions, lowering patient risks and costs.
Area of Science:
- Cardiology
- Transfusion Medicine
Background:
- Transfusion medicine practices have evolved due to blood-borne infection risks.
- American College of Physicians (ACP) guidelines for transfusion exist.
- Data on blood transfusion frequency, risk factors, and appropriateness after percutaneous coronary interventions (PCIs) are lacking.
Purpose of the Study:
- To analyze the frequency, predictors, and appropriateness of blood transfusions following PCIs.
- To assess adherence to modified ACP transfusion guidelines in this patient population.
Main Methods:
- Retrospective analysis of 628 consecutive PCI procedures.
- Multivariate logistic regression to identify transfusion predictors.
- Assessment of transfusion appropriateness using modified ACP guidelines.
Main Results:
- Blood transfusions were given in 8.9% of procedures.
- Independent predictors included age >70, female gender, longer procedure duration, coronary stenting, acute myocardial infarction, postprocedural heparin, and intra-aortic balloon pump placement.
- 64% of transfusions were deemed inappropriate based on ACP guidelines. Transfusion reactions occurred in 10% of appropriate and 5% of inappropriate transfusions. Costs were higher for appropriate transfusions.
Conclusions:
- Unnecessary blood transfusions are common after PCIs.
- Implementing ACP guidelines could significantly reduce inappropriate transfusions.
- Reducing unnecessary transfusions can mitigate patient risks and procedural costs.
Abstract:
Increased awareness of the risks of blood-borne infections has recently led to profound changes in the practice of transfusion medicine. These changes include, among others, the development of guidelines by the American College of Physicians (ACP) for transfusion. Although the incidence and predictors of vascular complications of percutaneous interventions have been well defined, there are currently no data on frequency, risk factors, and appropriateness of blood transfusions. We performed a retrospective analysis of 628 consecutive percutaneous coronary revascularization procedures. Predictors of blood transfusion were identified using multivariate logistic regression analysis. Appropriateness of transfusions was determined using modified ACP guidelines. Transfusions were administered after 8.9% of interventions (56 of 628). Multivariate analysis identified age >70 years, female gender, procedure duration, coronary stenting, acute myocardial infarction, postprocedural use of heparin and intra-aortic balloon pump placement as independent predictors of blood transfusions (all p <0.05). According to the ACP guidelines, 36 of 56 patients (64%) received transfusions inappropriately. Transfusion reactions (fever) occurred in 10% of patients who received tranfusions appropriately and in 5% of patients who received tranfusions inappropriately. The estimated additional costs per procedure related to transfusions were $551 and $419, respectively. In conclusion, unnecessary transfusions were performed frequently after percutaneous coronary interventions. Application of available guidelines could reduce the number of unnecessary transfusions, thus avoiding exposure of patients to additional risks and reducing procedural costs.