Today we will be discussing red blood cell transfusion in patients with heart disease and the growing body of evidence suggesting that transfusions in these patients may be associated with an increased risk of ischemic events or death. Some studies have shown that transfusions may activate platelets and cause vasoconstriction which may increase the risk of further ischemic events in patients with coronary artery disease.
Dr. Sunil Rao led a study published in JAMA and examined red cell transfusion practices in cardiac patients with percutaneous coronary interventions, or PCI. Dr. Rao comments on the subject: “We really don’t have a lot of good data to guide practice. The red cell transfusion guidelines that were released by the American Association of Blood Banks have a lot of great recommendations based on good data, but the one area in which they could not provide a recommendation was specifically with stable patients with ischemic heart disease.”
Dr. Rao and his research team evaluated data from almost 2 million PCI patients in over 1400 US hospitals.
Overall, the researchers found that 2.1% of all PCI patients were transfused; however, transfusion rates varied widely by hospital from zero to thirteen percent. Furthermore, they found that transfusions in PCI patients were associated with an increased risk of adverse outcomes such as heart attack, stroke, and death regardless of bleeding.
Dr. Rao elaborates: “Percutaneous coronary intervention is an invasive procedure and occurs on the background of potent thrombotic therapy, putting patients at risk for bleeding, and what we found was that across the board transfusion was associated with an increased risk of adverse outcomes except perhaps in patients who had received a post procedure bleeding event and had a hemoglobin value less than ten.”
This study demonstrates the need for randomized trials to evaluate red cell transfusion strategies in patients with coronary artery disease.
In the meantime, Dr. Rao advises: “Until further data are available it seems reasonable to withhold transfusion in a stable patient unless the hemoglobin value is 8 or less.”
We’ll be back with another edition of Transfusion News on April 15. Thanks for joining us.
1. Sherwood MW, Wang Y, Curtis JP, Peterson ED, Rao SV. Patterns and outcomes of red blood cell transfusion in patients undergoing percutaneous coronary intervention. JAMA : the journal of the American Medical Association 2014; 311(8): 836-43.