Unstable angina non ST elevation myocardial infarction complications of bleeding and transfusion - blood transfusions

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Unstable angina non ST elevation myocardial infarction complications of bleeding and transfusion - blood transfusions On the Web

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Template:MWT; Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.

Overview

With the advent and increased effective untilization of antiplatelet and anticoagulant agents in UA/NSTEMI the risk of overall mortality has reduced significantly however there is also an increased risk of bleeding complications indicating the need for blood transfusions.

Blood Transfusions

Inicidence

5-10% of NSTEMI patients receive blood transfusions.[1]

Indication

The appropriate use of blood transfusion administration is highly subjective due to lack of definitive data on transfusion triggers in patients with CAD. However, there is an association between transfusion and short-term mortality among NSTEMI patients.

Clinical Trial Data

  • Yang and colleagues analyzed data from 74,271 NSTEMI/unstable angina patients and found a significant association between blood transfusion and in-hospital mortality.[2]
  • Wu and colleagues analyzed 78,974 elderly patients with acute MI and associated the reception of blood transfusion with a significant increased risk of 30-day death when baseline hematocrit was > 33%.[3]
  • Rao and colleagues examined 24,111 NSTEMI patients and found that blood transfusion was associated with a significantly higher risk of 30-day mortality if the nadir hematocrit was > 24%.[4]

Given this equipoise, it seems reasonable to conclude that routine use of transfusion to maintain arbitrary hemoglobin levels in asymptomatic patients should be avoided.

References

  1. Sunil V. Rao, Karen Chiswell, Jie-Lena Sun, Christopher B. Granger, L. Kristin Newby, Frans Van de Werf, Harvey D. White, Paul W. Armstong, Robert M. Califf and Robert A. Harrington. International Variation in the Use of Blood Transfusion in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes. Am J Cardiol. 2008;101:25-29.
  2. Yang X, Alexander KP, Chen AY, Roe MT, Brindis RG, Rao SV, Gibler WB,Ohman EM, Peterson ED; CRUSADE Investigators. The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol. 2005;46:1490–1495.
  3. Wu W-C, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med. 2001;345:1230-1236.
  4. Rao SV, Jollis JG, Harrington RA, Granger CB, Newby LK, Armstrong PW, Moliterno DJ, Lindblad L, Pieper K, Topol EJ, Stamler JS, Califf RM. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA. 2004;292:1555– 62


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