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Study highlights 'significant' prevalence of blood transfusions in contemporary PCI
In a meta-analysis of 19 studies and more than 2 million patients, the mean prevalence of blood transfusions in contemporary PCI was 2.3%, and patients undergoing PCI who received blood transfusions had a threefold risk for mortality and MACE compared with patients who did not receive transfusions.
Researchers aimed to define the frequency of blood transfusions during PCI and how those transfusions predict clinical outcomes. The analysis included 19 published studies covering 2,258,711 patients who had more than 54,000 transfusions. The primary endpoints were mortality and MACE.
The crude mortality rate was 12.6% in an analysis of eight studies involving patients who received transfusions and 1.2% among all other patients. The crude MACE rate was 17.4% overall among patients who received transfusions and 3.1% among all other patients.
Results of the meta-analysis revealed an independent association between transfusions and mortality (OR = 3.02; 95% CI, 2.16-4.21) and MACE (OR = 3.15; 95% CI, 2.59-3.82).
The researchers observed similar MACE and mortality trends in studies including adjustment for baseline hematocrit, anemia and bleeding.
Patients with follow-up data longer than 1 year had increased rates of adverse outcomes (OR = 2.06; 95% CI, 1.61-2.64). Sensitivity analyses revealed significant differences in risk for mortality with higher transfusion volume (HR = 1.28; 95% CI, 1.19-1.38), red blood cell storage age (HR = 1.03; 95% CI, 1.02-1.05), platelet transfusion (HR = 3.92; 95% CI, 2.52-6.11) and plasma/cryoprecipitate transfusion (HR = 3.92; 95% CI, 2.52-6.11).
“Clinicians should minimize the risk of periprocedural bleeding complications during PCI through the use of bleeding-avoidance strategies such as the use of anticoagulants associated with reduced bleeding risk and use of the transradial access site approach for PCI, particularly in patients at high risk of bleeding complications,” the researchers concluded. “Clinicians should avoid the use of judicious blood transfusions after PCI in the absence of significant or active bleeding complications.” – by Rob Volansky
Disclosure: The researchers report no relevant financial disclosures.