• Mark M Smith, Daryl J Kor, Ryan D Frank, Timothy J Weister, Joseph A Dearani, and Matthew A Warner.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine, Rochester, MN. Electronic address: smith.mark2@mayo.edu.
• J. Cardiothorac. Vasc. Anesth. 2020 Jun 1; 34 (6): 1446-1456.

ObjectiveAssess outcomes after intraoperative plasma transfusion in patients undergoing cardiac surgery.DesignRetrospective study of adult cardiac surgical between 2011 and 2015. Relationships between plasma transfusion volume, coagulation test values, and a primary outcome of early postoperative red blood cell (RBC) transfusion were assessed via multivariable regression analyses. Secondary outcomes included hospital mortality, intensive care unit and hospital-free days, intraoperative RBCs, estimated blood loss, and reoperation for bleeding.SettingAcademic tertiary referral center.ParticipantsA total of 1,794 patients received intraoperative plasma transfusions during the study period.InterventionsNone.Measurements And Main ResultsHigher plasma transfusion volumes were associated with worse clinical outcomes, with each 1-unit increase being associated with greater odds for postoperative RBCs [odds ratio (OR) 1.12 (confidence interval [CI] 1.04-1.20); p = 0.002], intraoperative [OR 1.85 (CI 1.69-2.03); p < 0.001], and fewer hospital-free days [mean -0.20 (-0.39, -0.01); p = 0.04]. Each 0.1 increase in pretransfusion International Normalized Ratio (INR) was associated with increased odds of postoperative and intraoperative RBCs, reoperation for bleeding, and fewer intensive care unit and hospital-free days. For given plasma volumes, patients achieving greater reduction in elevated pretransfusion INR values experienced more favorable outcomes.ConclusionsIn patients undergoing cardiac surgery who received intraoperative plasma transfusion, higher plasma transfusion volumes were associated with inferior clinical outcomes. Higher pretransfusion INR values also were associated with worse outcomes; however, those achieving a greater degree of INR correction after plasma transfusion demonstrated more favorable outcomes. Prospective studies related to plasma transfusion are needed to address this important topic.Copyright © 2020 Elsevier Inc. All rights reserved.

14 keywords...

hide…