Abstract
BackgroundWhether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. To inform the design and conduct of a future clinical trial, we sought to describe transfusion practices, hemoglobin (Hb) triggers, and predictors of RBC transfusion in patients with aSAH.MethodsThis is a retrospective cohort study of all consecutively admitted adult patients with aSAH at four tertiary care centers from January 1, 2012, to December 31, 2013. Patients were identified from hospital administrative discharge records and existing local aSAH databases. Data collection by trained abstractors included demographic data, aSAH characteristics, Hb and transfusion data, other major aSAH cointerventions, and outcomes using a pretested case report form with standardized procedures. Descriptive statistics were used to summarize data, and regression models were used to identify associations between anemia, transfusion, and other relevant predictors and outcome.ResultsA total of 527 patients met inclusion eligibility. Mean (±SD) age was 57 ± 13 years, and 357 patients (67.7%) were female. The median modified Fisher grade was 4 (IQR 3–4). Mean nadir Hb was 98 ± 20 g/L and occurred on median admission day 4 (IQR 2–11). RBC transfusion occurred in 100 patients (19.0%). Transfusion rates varied across centers (12.1–27.4%, p = 0.02). Patients received a median of 1 RBC unit (IQR 1–2) per transfusion episode and a median total of 2 units (IQR 1–4). Median pretransfusion Hb for first transfusion was 79 g/L (IQR 74–93) and did not vary substantially across centers (78–82 g/L, p = 0.37). Of patients with nadir Hb < 80 g/L, 66.3% received a transfusion compared with 2.0% with Hb nadir ≥ 100 g/L (p < 0.0001). Predictors of transfusion were history of oral anticoagulant use, anterior circulation aneurysm, neurosurgical clipping, and lower Hb. Controlling for numerous potential confounders, transfusion was not independently associated with poor outcome.ConclusionsWe observed that moderate anemia remains very common early in admission following SAH. Only one-fifth of patients with SAH received RBC transfusions, mostly in cases of significant anemia (Hb < 80 g/L), and this did not appear to be associated with outcome.
Highlights
Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage is unclear
Patients who survive the primary event are at high risk of complications, including delayed cerebral ischemia (DCI) such as with vasospasm, which may result in further neurologic deficits and increased likelihood of death [1]
We identified potentially eligible patients by screening two sources: (1) hospital discharge abstracts, including all discharge abstracts that listed the diagnosis of primary SAH using International Classification of Diseases, Tenth Revision (ICD-10), codes (I60.0 to I60.9), and, where available, (2) local database or patient repositories, including all patients with a diagnosis of aneurysmal subarachnoid hemorrhage (aSAH) obtained from an existing local hospital, intensive care unit (ICU), or neurosurgical database
Summary
Whether a restrictive strategy for red blood cell (RBC) transfusion is applied to patients with aneurysmal subarachnoid hemorrhage (aSAH) is unclear. Medical complications, including anemia, are common and affect up to 50% of patients with aSAH [4]. Among them, both anemia and transfusion of red blood cells (RBC) have been associated with complications and poor outcomes [4]. Anemic patients with aSAH are more likely to receive RBC transfusions and at an increased risk of ischemic complications [4]. Those who receive RBC transfusions have been shown to have less favorable hospital outcomes, including severe disability [5]
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