Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders

Kenichi A Tanaka; Hisako Okada; Amir L Butt; Kofi B Vandyck; Srikiran Ramarapu; Cheryl L Maier; Roman M Sniecinski; Kenneth E Stewart

doi:10.1016/j.bja.2024.07.041

Use of coagulation factor concentrates and blood transfusion in cardiac surgery: a retrospective cohort study of adults with hereditary and acquired bleeding disorders

Br J Anaesth. 2024 Oct 18:S0007-0912(24)00554-3. doi: 10.1016/j.bja.2024.07.041. Online ahead of print.

Authors

Kenichi A Tanaka¹, Hisako Okada², Amir L Butt², Kofi B Vandyck², Srikiran Ramarapu², Cheryl L Maier³, Roman M Sniecinski⁴, Kenneth E Stewart⁵

Affiliations

¹ Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA. Electronic address: [email protected].
² Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
³ Department of Pathology, Emory Healthcare, Atlanta, GA, USA.
⁴ Department of Anesthesiology, Emory Healthcare, Atlanta, GA, USA.
⁵ Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA; Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

PMID: 39426922
DOI: 10.1016/j.bja.2024.07.041

Abstract

Background: Cardiac surgery poses a significant risk of perioperative bleeding and allogeneic blood transfusions, particularly in patients with bleeding disorders. Increasingly frequent use of coagulation factor concentrates could impact haemorrhagic risks, thromboembolic events, and costs. We describe the use of coagulation factor concentrates and allogeneic blood products in cardiac surgical patients with hereditary and acquired bleeding disorders to assess pertinent outcomes, including perioperative haemorrhage, thromboembolism, and hospital costs.

Methods: We conducted a retrospective cohort study using the Premier Health Database, including adult cardiac surgical patients diagnosed with hereditary or acquired bleeding disorders compared with those without bleeding disorders.

Results: Patients with acquired bleeding disorders required more extensive use of coagulation factor concentrates and blood products compared with those with hereditary bleeding disorders or without bleeding disorders. The highest exposures to coagulation factor concentrates were found in the acquired bleeding disorders group, with 24% receiving factor VIIa and 11.7% receiving prothrombin complex concentrate. This group also experienced significantly higher rates of complications, including a 15.8% rate of haemorrhage and a 19.2% rate of thromboembolic events. The acquired bleeding disorders group had longer intensive care and hospital stays, and the highest mortality rate (19.2%). The increased use of perioperative replacement of factor VIII and factor IX in the hereditary bleeding disorders group led to increased pharmacy costs but did not significantly impact blood bank charges.

Conclusions: Acquired bleeding disorders in cardiac surgery patients are associated with increased use of haemostatic interventions, postoperative complications, and increased healthcare costs. Improved management of perioperative haemostasis and thromboprophylaxis strategies are essential for optimising patient outcomes and reducing expenses.

Keywords: bleeding disorder; cardiac surgery; coagulation factor concentrate; healthcare cost; perioperative bleeding; perioperative complications; transfusion.