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Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm.
Eur J Vasc Endovasc Surg. 2016 Nov; 52(5):597-603.EJ

Abstract

OBJECTIVES

The aim was to study blood transfusions and blood product ratios in massively transfused patients treated for ruptured abdominal aortic aneurysms (rAAAs).

METHODS

This was a registry based cohort study of rAAA patients repaired at three major vascular centres between 2008 and 2013. Data were collected from the Swedish Vascular Registry, hospitals medical records, and local transfusion registries. The transfusion data were analysed for the first 24 h of treatment. Massive transfusion (MT) was defined as 4 or more units of red blood cell (RBC) transfused within 1 h, or 10 or more RBC units within 24 h. Logistic regression was used to calculate the odds ratio of 30 day mortality associated with the ratios of blood products and timing of first units of platelets (PLTs) and fresh frozen plasma (FFP) transfused.

RESULTS

Three hundred sixty nine rAAA patients were included: 80% men; 173 endovascular aneurysm repairs (EVARs) and 196 open repairs (ORs) with median RBC transfusion 8 units (Q1-Q3, 4-14) and 14 units (Q1-Q3, 8-28), respectively. A total of 261 (71%) patients required MT. EVAR patients with MT (n = 96) required less transfusion than OR patients (n = 165): median RBC 10 units (Q1-Q3, 6-16.5) vs. 15 units (Q1-Q3, 9-26) (p = .002), FFP 6 units (Q1-Q3, 2-14.5) vs. 13 units (Q1-Q3, 7-24) (p < .001), and PLT 0 units (Q1-Q3, 0-2) vs. 2 units (Q1-Q3, 0-4) (p = .01). Median blood product ratios in MT patients were FFP/RBC (EVAR group 0.59 [0.33-0.86], OR group 0.84 [0.67-1.2]; p < .001], and PLT/RBC (EVAR 0 [0-0.17], OR 0.12 (0-0.18); p < .001]. In patients repaired by OR a FFP/RBC ratio close to 1 was associated with reduced 30 day mortality (p = .003). The median PLT/RBC ratio was higher during the later part of the study period (p < .001, median test), whereas there was no significant difference in median FFP/RBC ratio (p = .101, median test).

CONCLUSION

The majority of rAAA patients undergoing EVAR required MT. EVAR patients treated with MT had lower FFP/RBC and PLT/RBC ratios than OR patients with MT. The mortality risk was lower with FFP/RBC ratio close to 1:1 in open repaired patients requiring MT. The 24 h PLT/RBC ratio increased over the study period.

Authors+Show Affiliations

Department of Vascular Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden. Electronic address: carl.montan@karolinska.se.Department of Biostatistics, Karolinska Institutet, Stockholm, Sweden.Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.Department of Transfusions Medicine and Immunology, Skåne University Hospital, Lund University, Sweden.Department of Vascular Surgery, Södersjukhuset, Stockholm, Sweden; Department of Vascular Surgery, Karolinska Institutet, Stockholm, Sweden.Department of Vascular Surgery, Skåne University Hospital, Lund University, Lund, Sweden.Department of Vascular Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27605360

Citation

Montan, C, et al. "Massive Blood Transfusion in Patients With Ruptured Abdominal Aortic Aneurysm." European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, vol. 52, no. 5, 2016, pp. 597-603.
Montan C, Hammar U, Wikman A, et al. Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg. 2016;52(5):597-603.
Montan, C., Hammar, U., Wikman, A., Berlin, E., Malmstedt, J., Holst, J., & Wahlgren, C. M. (2016). Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm. European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery, 52(5), 597-603. https://doi.org/10.1016/j.ejvs.2016.07.023
Montan C, et al. Massive Blood Transfusion in Patients With Ruptured Abdominal Aortic Aneurysm. Eur J Vasc Endovasc Surg. 2016;52(5):597-603. PubMed PMID: 27605360.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Massive Blood Transfusion in Patients with Ruptured Abdominal Aortic Aneurysm. AU - Montan,C, AU - Hammar,U, AU - Wikman,A, AU - Berlin,E, AU - Malmstedt,J, AU - Holst,J, AU - Wahlgren,C M, Y1 - 2016/09/04/ PY - 2015/09/07/received PY - 2016/07/19/accepted PY - 2016/9/9/pubmed PY - 2018/1/9/medline PY - 2016/9/9/entrez KW - Blood product ratios KW - Blood transfusion KW - Endovascular aneurysm repair KW - Fresh frozen plasma KW - Open repair KW - Platelets KW - Ruptured abdominal aortic aneurysm SP - 597 EP - 603 JF - European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery JO - Eur J Vasc Endovasc Surg VL - 52 IS - 5 N2 - OBJECTIVES: The aim was to study blood transfusions and blood product ratios in massively transfused patients treated for ruptured abdominal aortic aneurysms (rAAAs). METHODS: This was a registry based cohort study of rAAA patients repaired at three major vascular centres between 2008 and 2013. Data were collected from the Swedish Vascular Registry, hospitals medical records, and local transfusion registries. The transfusion data were analysed for the first 24 h of treatment. Massive transfusion (MT) was defined as 4 or more units of red blood cell (RBC) transfused within 1 h, or 10 or more RBC units within 24 h. Logistic regression was used to calculate the odds ratio of 30 day mortality associated with the ratios of blood products and timing of first units of platelets (PLTs) and fresh frozen plasma (FFP) transfused. RESULTS: Three hundred sixty nine rAAA patients were included: 80% men; 173 endovascular aneurysm repairs (EVARs) and 196 open repairs (ORs) with median RBC transfusion 8 units (Q1-Q3, 4-14) and 14 units (Q1-Q3, 8-28), respectively. A total of 261 (71%) patients required MT. EVAR patients with MT (n = 96) required less transfusion than OR patients (n = 165): median RBC 10 units (Q1-Q3, 6-16.5) vs. 15 units (Q1-Q3, 9-26) (p = .002), FFP 6 units (Q1-Q3, 2-14.5) vs. 13 units (Q1-Q3, 7-24) (p < .001), and PLT 0 units (Q1-Q3, 0-2) vs. 2 units (Q1-Q3, 0-4) (p = .01). Median blood product ratios in MT patients were FFP/RBC (EVAR group 0.59 [0.33-0.86], OR group 0.84 [0.67-1.2]; p < .001], and PLT/RBC (EVAR 0 [0-0.17], OR 0.12 (0-0.18); p < .001]. In patients repaired by OR a FFP/RBC ratio close to 1 was associated with reduced 30 day mortality (p = .003). The median PLT/RBC ratio was higher during the later part of the study period (p < .001, median test), whereas there was no significant difference in median FFP/RBC ratio (p = .101, median test). CONCLUSION: The majority of rAAA patients undergoing EVAR required MT. EVAR patients treated with MT had lower FFP/RBC and PLT/RBC ratios than OR patients with MT. The mortality risk was lower with FFP/RBC ratio close to 1:1 in open repaired patients requiring MT. The 24 h PLT/RBC ratio increased over the study period. SN - 1532-2165 UR - https://www.unboundmedicine.com/medline/citation/27605360/Massive_Blood_Transfusion_in_Patients_with_Ruptured_Abdominal_Aortic_Aneurysm_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1078-5884(16)30268-4 DB - PRIME DP - Unbound Medicine ER -