Impact of transfusion on stroke after cardiovascular interventions: Meta-analysis of comparative studies

Purpose: To evaluate the impact of transfusion on the development of stroke after cardiovascular interventions.

Methods: A literature search was performed to identify comparative studies on the impact of blood transfusion on the occurrence of stroke after adult cardiac surgery and interventional cardiology procedures.

Results: Twenty-four studies compared the outcome of 80 283 patients who received and 2 260 709 patients who did not receive blood transfusion after cardiovascular interventions. Pooled analysis showed that transfused patients had a higher risk of postoperative stroke (2.1% vs 0.9%; P < .001; risk ratio [RR], 2.563; 95% confidence interval [CI], 1.615-4.069; I² = 94%) compared with patient who did not receive blood transfusion. The leave-one-out analysis confirmed the consistency of the overall series (RR ranged from 2.367 [95% CI, 1.978-2.834] to 2.676 [95% CI, 1.679-4.265]). Transfusion was associated with increased risk of stroke after either interventional cardiology interventions (3.2% vs 1.1%; RR, 3.325; 95% CI, 1.579-7.004) or cardiac surgery (1.9% vs 0.8%; RR, 2.260; 95% CI, 1.845-2.769). Generic inverse variance analysis of 11 studies reporting adjusted odds ratios for baseline characteristics showed that transfusion after cardiovascular interventions was an independent predictor of stroke (RR, 1.53; 95% CI, 1.10-2.14; I² = 0%).

Conclusion: Blood transfusion is associated with a significantly increased risk of postoperative stroke in patients undergoing cardiovascular interventions.

Registration: The present meta-analysis is registered in PROSPERO, code CRD42016046426.