Blood transfusions increase the risk for venous thromboembolism events following total joint arthroplasty

Shohat, Noam; Ludwick, Leanne; Goh, Graham S.; Sherman, Matthew; Paladino, Joseph Robert; Parvızı, Javad

doi:10.1038/s41598-021-00263-0

Cited by 17 publications

(19 citation statements)

References 33 publications

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“…Acuña et al [ 22 ] found that the receipt of a postoperative transfusion was relevant to an increased risk of VTE in 333, 463 patients with total knee arthroplasty. Furthermore, another single-center retrospective cohort study also confirmed that the risk of VTE following total joint arthroplasty increased by approximately three-fold when blood transfusions were prescribed [ 7 ]. Patients often receive acute transfusion during the perioperative period.…”

Section: Discussionmentioning

confidence: 93%

“…However, as both TH and PSH are associated with hypercoagulability and inflammatory response. One might speculate that the observed excess VTE risk could be related to increased blood viscosity and inflammation [ 7 , 35 , 36 ]. Thus, it is likely to speculate that a biological interaction between TH and PSH on the risk of VTE could be mediated via procoagulant changes arising from two sources.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that a transfusion history (TH) could increase the risk of VTE [ 6 , 7 ]. Transfused red blood cells have been proposed to modulate the inflammatory cascade [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

Sun

Wang

et al. 2023

Thrombosis J

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Background Blood transfusion and previous stroke history are two independent risk factors of venous thromboembolism (VTE) in stroke patients. Whether the potential interaction of transfusion history and previous stroke history is associated with a greater risk of VTE remains unclear. This study aims to explore whether the combination of transfusion history and previous stroke history increases the risk of VTE among Chinese stroke patients. Methods A total of 1525 participants from the prospective Stroke Cohort of Henan Province were enrolled in our study. Multivariate logistic regression models were used to explore the associations among transfusion history, previous stroke history and VTE. The interaction was evaluated on both multiplicative and additive scales. The odds ratio (95% CI), relative excess risk of interaction (RERI), attributable proportion (AP), and synergy index (S) of interaction terms were used to examine multiplicative and additive interactions. Finally, we divided our population into two subgroups by National Institutes of Health Stroke Scale (NIHSS) score and re-evaluated the interaction effect in both scales. Results A total of 281 (18.4%) participants of 1525 complicated with VTE. Transfusion and previous stroke history were associated with an increased risk of VTE in our cohort. In the multiplicative scale, the combination of transfusion and previous stroke history was statistically significant on VTE in both unadjusted and adjusted models (P<0.05). For the additive scale, the RERI shrank to 7.016 (95% CI: 1.489 ~ 18.165), with the AP of 0.650 (95% CI: 0.204 ~ 0.797) and the S of 3.529 (95% CI: 1.415 ~ 8.579) after adjusting for covariates, indicating a supra-additive effect. In subgroups, the interaction effect between transfusion history and previous stroke history was pronouncedly associated with the increased risk of VTE in patients with NIHSS score > 5 points (P<0.05). Conclusions Our results suggest that there may be a potential synergistic interaction between transfusion history and previous stroke history on the risk of VTE. Besides, the percentage of VTE incidence explained by interaction increased with the severity of stroke. Our findings will provide valuable evidence for thromboprophylaxis in Chinese stroke patients.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

Sun

Wang

et al. 2023

Thrombosis J

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“…For all hip fracture patients over the study period who received TXA, the median dose was 2 g of intravenous (IV) TXA administered intraoperatively in 2 divided doses on incision and closure. Control variables were determined a priori 12 on the basis of previous work demonstrating associations with the outcomes of interest [13][14][15][16][17] . The following patient variables were included: age, sex, body mass index (BMI), Charlson Comorbidity Index, ASA class, and preoperative tobacco use.…”

Section: Methodsmentioning

confidence: 99%

Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Intertrochanteric Fracture

Porter

Spaulding

Duncan

et al. 2022

Journal of Bone and Joint Surgery

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Background: For elective total joint arthroplasty, tranexamic acid (TXA) is considered safe and efficacious. However, evidence of TXA's safety in high-risk patients undergoing nonelective surgery for hip fracture is sparse. This study aimed to assess whether TXA administration to high-risk patients with an intertrochanteric (IT) hip fracture increased the risk of thromboembolic complications or mortality.Methods: All patients treated surgically for IT hip fracture between 2015 and 2019 across 4 hospitals of a single hospital system were considered. High-versus low-risk patients and those receiving TXA versus no TXA treatment were identified. Propensity scores adjusted for risk differences between patient groups with TXA and no TXA administration were calculated for (1) high-risk patients (n = 141) and ( 2) the entire population (n = 316). Postoperative mortality, deep venous thrombosis (DVT), pulmonary embolism (PE), myocardial infarction (MI), and stroke within 90 days of surgery were evaluated.Results: No association between TXA administration and increased risk of mortality or complications in either group was identified. Specifically, out of 282 matched high-risk patients, no differences in mortality (odds ratio [OR], 0.97 [95% confidence interval (CI), 0.90, 1.05]), DVT (OR, 0.97 [95% CI, 0.93, 1.00]), PE (OR 1.00 [95% CI, 0.95, 1.05]), MI (OR, 1.04 [95% CI, 0.98, 1.10]), or stroke (OR, 1.00 [95% CI, 0.95, 1.05]) were identified.Conclusions: In our review of propensity-matched high-risk patients undergoing surgical repair for IT fracture, we found that TXA administration compared with no TXA administration was not associated with an increased risk of mortality, DVT, PE, MI, or stroke within 90 days of surgery.

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“…Most observational studies investigating VTE ignored the role of allogeneic blood transfusion as a causal factor. Few studies found in cancer and after surgery that blood transfusions were dosedependently associated with VTE [74][75][76]. One study in 1070 patients undergoing cardiac surgery found a dose-dependent association with transfusion of blood products and VTE [77].…”

Section: Allogeneic Transfusion and Thrombosismentioning

confidence: 99%

Clinical Effects and Possible Mechanisms of Transfusion-Related Immunomodulation

Bilgin¹

2023

Thalassemia Syndromes - New Insights and Transfusion Modalities

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Allogeneic blood components are commonly transfused in trauma, surgery, and intensive care units and are related with adverse effects, such as postoperative infections, multi-organ failure, and mortality. The adverse effects of blood transfusions on the immune system are called as transfusion-related immunomodulation (TRIM). Many clinical trials are conducted to show the clinical effects of TRIM. They found in different clinical settings controversial results. There are many possible mechanisms of TRIM. Although until now, the exact mechanisms are not elucidated resulting in a challenge to unravel this complex interaction between immunomodulation and clinical events leading to morbidity and mortality. It has been postulated that allogeneic leukocytes are associated with the clinical adverse effects of TRIM that predominantly is observed in high-risk patients as cardiovascular surgery. Allogeneic leukocytes could activate inflammation cascade leading to adverse events in high-risk patients. Also other blood components as red cells, plasma, and platelets can play a role in the development of inflammatory complications after blood transfusions. In this review, we will discuss the clinical effects and the possible mechanisms of TRIM in relation with allogeneic leukocytes and mediators derived from allogeneic blood transfusions.

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Blood transfusions increase the risk for venous thromboembolism events following total joint arthroplasty

Cited by 17 publications

References 33 publications

The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

The interaction effect of transfusion history and previous stroke history on the risk of venous thromboembolism in stroke patients: a prospective cohort study

Tranexamic Acid Was Not Associated with Increased Complications in High-Risk Patients with Intertrochanteric Fracture

Clinical Effects and Possible Mechanisms of Transfusion-Related Immunomodulation

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