Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients

Fausto Biancari (1) , Tuomas Tauriainen (1) , Andrea Perrotti (2) , Magnus Dalén (3) , Giuseppe Faggian (4) , Ilaria Franzese (4) , Sidney Chocron (2) , Vito G. Ruggieri (5) , Karl Bounader (5) , Helmut Gulbins (6) , Daniel Reichart (6) , Peter Svenarud (7) , Giuseppe Santarpino (8) , Theodor Fischlein (8) , Tamas Puski (8) , Daniele Maselli (9) , Carmelo Dominici (9) , Saverio Nardella (9) , Riccardo Gherli (10) , Francesco Musumeci (10) , Antonino S. Rubino (11) , Carmelo Mignosa (11) , Marisa de Feo (12) , Ciro Bancone (12) , Giuseppe Gatti (13) , Luca Maschietto (13) , Francesco Santini (14) , Antonio Salsano (14) , Francesco Nicolini (15) , Tiziano Gherli (15) , Marco Zanobini (16) , Matteo Saccocci (16) , Paola d'Errigo (17) , Eeva-Maija Kinnunen (1) , Francesco Onorati (8)

1 Oulu University Hospital [Oulu]
2 Service de Chirurgie Cardiaque [CHU Besançon]
3 Karolinska Institutet [Stockholm]
4 University Hospital of Verona
5 CHU Pontchaillou [Rennes]
6 University Heart Center Hamburg
7 Karolinska University Hospital [Stockholm]
8 PMU - Paracelsus Medizinische Privatuniversität = Paracelsus Medical University
9 St Anna Hospital
10 S. Camillo-Forlanini Hospital
11 Morgagni-Pierantoni Hospital
12 University of Naples Federico II = Università degli studi di Napoli Federico II
13 Ospedali Riuniti
14 UniGe - Università degli studi di Genova = University of Genoa
15 UNIPR - Università degli studi di Parma = University of Parma
16 IRCCS - Istituti di Ricovero e Cura a Carattere Scientifico
17 Istituto Superiore di Sanita [Rome]

INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery. METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions. RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding. CONCLUSIONS: Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.

Keywords: Cardiac surgery; Transfusion; Stroke; Coronary artery bypass surgery; Coronary artery bypass grafting; Bleeding

Domains: Life Sciences [q-bio]; Human health and pathology; Surgery; Life Sciences [q-bio]; Human health and pathology; Cardiology and cardiovascular system; Life Sciences [q-bio]; Santé publique et épidémiologie

Fausto Biancari, Tuomas Tauriainen, Andrea Perrotti, Magnus Dalén, Giuseppe Faggian, et al.. Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients. International Journal of Surgery, 2016, 32, pp.50-57. ⟨10.1016/j.ijsu.2016.06.032⟩. ⟨hal-01593109⟩