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Incidence and prognostic impact of bleeding and transfusion after coronary surgery in low‐risk patients
Author(s) -
Kinnunen EevaMaija,
De Feo Marisa,
Reichart Daniel,
Tauriainen Tuomas,
Gatti Giuseppe,
Onorati Francesco,
Maschietto Luca,
Bancone Ciro,
Fiorentino Francesca,
Chocron Sidney,
Bounader Karl,
Dalén Magnus,
Svenarud Peter,
Faggian Giuseppe,
Franzese Ilaria,
Santarpino Giuseppe,
Fischlein Theodor,
Maselli Daniele,
Dominici Carmelo,
Nardella Saverio,
Gherli Riccardo,
Musumeci Francesco,
Rubino Antonino S.,
Mignosa Carmelo,
Mariscalco Giovanni,
Serraino Filiberto G.,
Santini Francesco,
Salsano Antonio,
Nicolini Francesco,
Gherli Tiziano,
Zanobini Marco,
Saccocci Matteo,
Ruggieri Vito G.,
Philippe Verhoye Jean,
Perrotti Andrea,
Biancari Fausto
Publication year - 2017
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.13885
Subject(s) - medicine , perioperative , blood transfusion , euroscore , incidence (geometry) , stroke (engine) , cardiac surgery , surgery , artery , severe bleeding , adverse effect , prospective cohort study , cardiology , mechanical engineering , physics , optics , engineering
BACKGROUND Excessive bleeding and blood transfusion are associated with adverse outcome after cardiac surgery, but their mechanistic effects are difficult to disentangle in patients with increased operative risk. This study aimed to evaluate the incidence and prognostic impact of bleeding and transfusion of blood products in low‐risk patients undergoing coronary artery bypass grafting (CABG). STUDY DESIGN AND METHODS Sixteen tertiary European centers of cardiac surgery contributed to the prospective European registry of CABG (E‐CABG). The severity of bleeding was defined by the E‐CABG bleeding severity classification and universal definition of perioperative bleeding (UDPB) classification. RESULTS Of 1213 patients with EuroSCORE II of less than 2% (mean, 1.1 ± 0.4%), 18.5% suffered from mild bleeding (E‐CABG bleeding Grade 1) and 3.4% experienced severe bleeding (E‐CABG bleeding Grade 2‐3). Similarly, 19.7% had UDPB Class 2 and 5.9% had UDPB Classes 3 and 4. Mild and severe bleeding defined by the E‐CABG and UDPB classifications were associated with an increased risk of several adverse events as adjusted by multiple covariates. The risk of death, stroke, and acute kidney injury was particularly increased in patients with severe bleeding. CONCLUSION Severe bleeding is rather uncommon in low‐risk patients undergoing CABG, but it is associated with an increased risk of major adverse events. Prevention of excessive perioperative bleeding and patient blood management may improve the outcome of cardiac surgery also in low‐risk patients.