Neurocritical Care

, Volume 20, Issue 1, pp 84–90

Red Blood Cell Transfusion Increases the Risk of Thrombotic Events in Patients with Subarachnoid Hemorrhage

  • Monisha A. Kumar
  • Torrey A. Boland
  • Mohamed Baiou
  • Michael Moussouttas
  • Jay H. Herman
  • Rodney D. Bell
  • Robert H. Rosenwasser
  • Scott E. Kasner
  • Valerie E. Dechant
ORIGINAL ARTICLE

DOI: 10.1007/s12028-013-9819-0

Cite this article as:
Kumar, M.A., Boland, T.A., Baiou, M. et al. Neurocrit Care (2014) 20: 84. doi:10.1007/s12028-013-9819-0

Abstract

Background and Purpose

Red blood cell transfusion (RBCT) may increase the risk of thrombotic events (TE) in patients with subarachnoid hemorrhage (SAH) through changes induced by storage coupled with SAH-related hypercoagulability. We sought to investigate the association between RBCT and the risk of TE in patients with SAH.

Methods

205 consecutive patients with acute, aneurysmal SAH admitted to the neurovascular intensive care unit of a tertiary care, academic medical center between 3/2008 and 7/2009 were enrolled in a retrospective, observational cohort study. TE were defined as the composite of venous thromboembolism (VTE), myocardial infarction (MI), and cerebral infarction noted on brain CT scan. Secondary endpoints included the risk of VTE, poor outcome (modified Rankin score 3–6 at discharge), and in-hospital mortality.

Results

86/205 (42 %) received RBCT. Eighty-eight (43 %) had a thrombotic complication. Forty (34 %) of 119 non-transfused and 48/86 (56 %) transfused patients had a TE (p = 0.002). In multivariate analysis, RBCT was associated with more TE by [OR 2.4; 95 % CI (1.2, 4.6); p = 0.01], VTE [OR 2.3; 95 % CI (1.0, 5.2); p = 0.04], and poor outcome [OR 5.0; 95 % CI (1.9, 12.8); p < 0.01]. The risk of TE increased by 55 % per unit transfused when controlling for univariate variables. Neither mean nor maximum age of blood was significantly associated with thrombotic risk.

Conclusions

RBCT is associated with an increased risk of TE and VTE in SAH patients. A dose-dependent relationship exists between number of units transfused and thrombosis. Age of blood does not appear to play a role.

Keywords

Subarachnoid hemorrhageHypercoagulableVasospasmDelayed cerebral ischemiaTransfusionRed blood cellVenous thromboembolism

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Monisha A. Kumar
    • 1
    • 2
    • 3
  • Torrey A. Boland
    • 4
  • Mohamed Baiou
    • 5
  • Michael Moussouttas
    • 5
  • Jay H. Herman
    • 6
  • Rodney D. Bell
    • 5
  • Robert H. Rosenwasser
    • 7
  • Scott E. Kasner
    • 1
  • Valerie E. Dechant
    • 8
  1. 1.Department of NeurologyHospital of the University of Pennsylvania, University of PennsylvaniaPhiladelphiaUSA
  2. 2.Department of NeurosurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Anesthesiology and Critical CareUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of NeurologyMassachusetts General HospitalBostonUSA
  5. 5.Department of NeurologyThomas Jefferson University HospitalsPhiladelphiaUSA
  6. 6.Transfusion Medicine Service, Department of Pathology, Anatomy and Cell BiologyThomas Jefferson UniversityPhiladelphiaUSA
  7. 7.Department of NeurosurgeryJefferson Hospital for Neuroscience Thomas Jefferson University HospitalsPhiladelphiaUSA
  8. 8.Department of NeurologyChristiana Care Health SystemNewarkUSA