Abstract 11039: Role of Blood Transfusion Product Type and Dose in Deep Vein Thrombosis (DVT) After Cardiac Surgery
Objective: Postoperative DVT is associated with significant morbidity and possibly death. We previously reported a 13% incidence of mostly silent DVT after cardiac surgery despite implementing maximal thromboprophylaxis, and that DVTs were predicted by increasing age, prolonged ventilation/no ambulation, and if transfusion occurred.This Transfusion-DVT association remains incompletely elucidated to date, and we hypothesized it will vary with product type and increase with transfusion dose.
Methods: Detailed RBC, Platelets (PLT), FFP and Cryoprecipitate units (u) data were collected for 1070 cardiac surgery patients evaluated with serial postoperative duplex venous scans (DVS) until discharge. Incidence of DVT was studied for used blood type combinations and dose categories (ref = 0 units). Adjusted Odds Ratios [OR(95% confidence interval)] were derived via multivariate logistic regression.
Results: DVT occurred in 139 (13%) patients. Transfusion was used in 506 (47%) patients: RBC [468 (44%); 4.0±4.2u]; FFP [155 (14.5%); 3.5±2.3u]; PLT [185 (17.3%); 2.2±1.3u] and Cryo [51 (4.8%); 1.3±0.6u]. Isolated RBC transfusion accounted for 92.6% (287/310) patients receiving one product, and their DVT rate was increased considerably compared to no transfusion (16.7% vs 7.3%; P<0.001). Incidence of DVT increased substantially for multiple product transfusions particularly for RBC+FFP.(Fig A) Multivariate analysis identified a significant RBC-DVT dose-dependence that was modulated by a RBC*FFP interaction term [OR=1.88(1.10-3.20); p=0.022].(Fig B)
Conclusion: Even when ACCP recommended thromboprophylaxis is followed, RBC transfusion increases the likelihood of DVT after cardiac surgery in a dose-dependent fashion that is exacerbated when RBC provision is accompanied with FFP. These results indicate that postoperative diagnostic DVS are warranted in this high risk for DVT population to facilitate timely therapeutic intervention.
- © 2012 by American Heart Association, Inc.