Abstract T P325: The Role Of A History Of Coronary Artery Disease, The Need For Transfusion And Outcomes In Patients With Intracerebral Hemorrhage

Abstract

Background and Purpose: In patients with primary ICH, RBC transfusion (RBCT) may be detrimental and platelet transfusion effects are controversial. Different transfusion thresholds have been suggested in patients with coronary artery disease (CAD). We examined the relationship between transfusion and outcomes in ICH patients with and without CAD. Methods: A retrospective review of consecutive patients with primary ICH admitted to two academic stroke centers from 2008-2013 was conducted. Patients age<18 years, in-hospital strokes and outside hospital transfers were excluded. Primary outcome was discharge mRS of 5-6. Logistic regression was used to assess the association with outcomes. Results: Out of 456 patients identified, 50 (11.2%) had CAD on admission. CAD patients were older (68 vs. 61; p=0.001). There was no significant difference in frequency of RBCT between patients who had CAD compared to those without (6% vs. 9%; p=0.53). The frequency of platelet transfusion was higher in patients with CAD (26% vs. 7%; p<0.0001). This association was significant after adjusting for ICH score (OR 3.83; 95% CI 1.13-12.9; p=0.031). Patients with RBCT were at greater odds of having a mRS of 5-6 (OR 5.60, 95% CI 2.42-12.9, p<0.001) compared to those without. After adjusting for admission hematocrit, ICH score, and CAD the association between RBCT and mRS remained significant (OR 16.3, 95% CI 2.11-125.9, p=0.007). Patients with platelet transfusion were at greater odds of having a mRS of 5-6 on univariable analysis (OR 2.85; 95% CI 1.42-5.71; p=0.003). This association is no longer significant after adjusting for ICH score, CAD and admission hematocrit (OR 2.88; 95%CI 0.67-12.3; p=0.15). In patients with ICH score 0-2, platelet transfusion is significantly associated with a mRS of 5-6 after adjusting for CAD (OR 2.48; 95%CI 1.16-5.35; p=0.02). Conclusions: A history of CAD is not associated with increased frequency of RBCT in ICH compared to patients without CAD, but it is significantly associated with a higher frequency of platelet transfusion. RBCT was significantly associated with poor short-term functional outcomes regardless of CAD history. In patients with low ICH scores, platelet transfusion was significantly associated with poor functional outcomes.