Red Blood Cell Transfusion Increases the Risk of Thrombotic Events in Patients with Subarachnoid Hemorrhage

Abstract

RBCT is associated with an increased risk of TE and VTE in SAH patients. A dose-dependent relationship exists between number of units transfused and thrombosis. Age of blood does not appear to play a role.

Red blood cell transfusion and outcomes in acute pulmonary embolism

“…These considerations continue to challenge clinicians to balance the risks and benefits of treating anaemia with transfusions, and have led to controversies on whether transfusion should be administered to anaemic patients in the absence of compelling clinical reasons, such as severe symptoms or haemodynamic instability. RBC transfusions have been associated with increased mortality and poor outcomes in patients with subarachnoid haemorrhage due to increased risk of thrombotic events . Conversely, administering RBC transfusions to patients with ischaemic stroke did not worsen their prognosis, although the treatment was associated with longer duration of mechanical ventilation and length of stay in intensive care units .…”

“…Anaemia is associated with higher morbidity and mortality in patients with acute and chronic cardiopulmonary diseases, including acute myocardial infarction, heart failure, pneumonia and COPD . Treating anaemia with red blood cell (RBC) transfusion after acute myocardial infarction, congestive heart failure and ischaemic stroke is controversial and has been linked with adverse outcomes . Acute pulmonary embolism (PE) is the third leading cause of cardiovascular death after coronary artery disease and stroke .…”

Risks associated with preoperative anemia and perioperative blood transfusion in open surgery for intracranial aneurysms

“…10,31 Three studies assessing the frequent use of transfusion in patients with subarachnoid hemorrhage suggested that transfusion was associated with worse outcomes, including greater risk for vasospasm, thrombotic events, and death. 23,25,35 However, a small randomized trial in patients with subarachnoid hemorrhage found that maintaining higher hemoglobin levels via transfusion may be safe and feasible. 28 A recent systematic review of neurocritically ill patients concluded that sufficient evidence does not exist to allow distinction between the efficacy of a lower or higher threshold of transfusion in these patients.…”

Diffuse Alveolar Haemorrhage Complicated by Pulmonary Embolism—Problems with Treatment

“…The impact of transfusions cannot be excluded as a risk factor for VTE, too. Kumar et al [13] presented a relationship between the red blood transfusion and an increased risk of VTE in neurological patients (with subarachnoid haemorrhage). A dose-dependent association exists between the number of units transfused and thrombosis, the age of blood does not appear to play a role.…”