Bleeding Risk Stratification in Coronary Artery Surgery the Should-Not-Bleed Score

Abstract

BackgroundCardiac surgery has an estimated 20% of the total blood transfusions. Of those, 11% were utilized in patients undergoing coronary artery bypass grafting (CABG) with documented wide variability in transfusion rate (7.8% to 92.8%). To address the issue of unnecessary transfusions within CABG population, we developed the model to predict the patients at low risk of bleeding who should not be transfused. Herein we present our “SHOULD-NOT-BLEED-SCORE” application developed for Windows® software platform and based on our previous research.MethodsThis study aimed to develop the user-friendly application that stratifies the patients with respect to bleeding risk. The statistical model we used in our previous research was focused on detection of CABG patients at low risk of bleeding. The rationale behind such an approach was to identify among CABG patients subgroup at low risk of bleeding. By identifying patients at low risk of bleeding we can define the subgroup of patients who should not be transfused. We developed the Windows platform application based on risk modelling we previously calculated on 1426 patients undergoing elective CABG from January 2010 to January 2018.ResultsThe SHOULD-NOT-BLEED-SCORE risk score is developed for Windows software platform. The mathematical model based on multivariate analysis was used for app development. The variables that entered the scoring system were: Age; Body Mass Index; Chronic Renal Failure; Preoperative Clopidogrel Exposure; Preoperative Red Blood Cells Count; Preoperative Fibrinogen Level; Preoperative Multiplate ASPI test (AUC). The SHOULD-NOT-BLEED-SCORE identifies/predicts patients without excessive bleeding with the strong discriminatory performance (ROC analysis AUC 72.3%, p<0.001).ConclusionThe SHOULD-NOT-BLEED risk scoring application may be useful in preoperative risk screening process. The clinical and economic burden associated with unnecessary transfusions may be adequately addressed by preoperative scoring system detecting patients at low risk of bleeding who should not be transfused.