1. Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients
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Marco Zanobini, Giovanni Mariscalco, Luca Maschietto, Fausto Biancari, Tiziano Gherli, Francesco Santini, Vito G. Ruggieri, Saverio Nardella, Daniele Maselli, Tuomas Tauriainen, Paola D'Errigo, Daniel Reichart, Francesco Musumeci, Antonino S. Rubino, Giuseppe Santarpino, Francesco Onorati, Sidney Chocron, Antonio Salsano, Marisa De Feo, Ciro Bancone, Riccardo Gherli, Tamas Püski, Karl Bounader, Theodor Fischlein, Andrea Perrotti, Carmelo Mignosa, Matteo Saccocci, Giuseppe Faggian, Helmut Gulbins, Giuseppe Gatti, Carmelo Dominici, Francesco Nicolini, Peter Svenarud, Eeva-Maija Kinnunen, Ilaria Franzese, Magnus Dalén, Oulu University Hospital [Oulu], Service de Chirurgie Cardiaque [CHU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Karolinska Institutet [Stockholm], University Hospital of Verona, CHU Pontchaillou [Rennes], University Heart Center Hamburg, Karolinska University Hospital [Stockholm], Paracelsus Medizinische Privatuniversität = Paracelsus Medical University (PMU), St Anna Hospital, S. Camillo-Forlanini Hospital, Morgagni-Pierantoni Hospital, Università degli studi di Napoli Federico II, Ospedali Riuniti, University of Genoa (UNIGE), University of Parma = Università degli studi di Parma [Parme, Italie], Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Superiore di Sanita [Rome], Biancari, Fausto, Tauriainen, Tuoma, Perrotti, Andrea, Dalén, Magnu, Faggian, Giuseppe, Franzese, Ilaria, Chocron, Sidney, Ruggieri, Vito G., Bounader, Karl, Gulbins, Helmut, Reichart, Daniel, Svenarud, Peter, Santarpino, Giuseppe, Fischlein, Theodor, Puski, Tama, Maselli, Daniele, Dominici, Carmelo, Nardella, Saverio, Mariscalco, Giovanni, Gherli, Riccardo, Musumeci, Francesco, Rubino, Antonino S., Mignosa, Carmelo, DE FEO, Marisa, Bancone, Ciro, Gatti, Giuseppe, Maschietto, Luca, Santini, Francesco, Salsano, Antonio, Nicolini, Francesco, Gherli, Tiziano, Zanobini, Marco, Saccocci, Matteo, D'Errigo, Paola, Kinnunen, Eeva Maija, Onorati, Francesco, University of Naples Federico II = Università degli studi di Napoli Federico II, Università degli studi di Genova = University of Genoa (UniGe), Università degli studi di Parma = University of Parma (UNIPR), and Istituto Superiore di Sanità (ISS)
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Registrie ,Male ,Blood transfusion ,medicine.medical_treatment ,Coronary artery bypass grafting ,030204 cardiovascular system & hematology ,law.invention ,Coronary artery bypass surgery ,0302 clinical medicine ,law ,Risk Factors ,Prospective Studies ,Registries ,Coronary Artery Bypass ,Prospective cohort study ,Stroke ,Bleeding ,Cardiac surgery ,Transfusion ,Aged ,Cardiopulmonary Bypass ,Female ,Hemorrhage ,Heparin ,Humans ,Middle Aged ,Postoperative Hemorrhage ,Surgery ,Cardiopulmonary Bypa ,General Medicine ,3. Good health ,Human ,Cohort study ,medicine.medical_specialty ,[SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery ,03 medical and health sciences ,[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system ,Cardiopulmonary bypass ,medicine ,business.industry ,Coronary Artery Bypa ,Risk Factor ,Bleeding, Cardiac surgery, Coronary artery bypass grafting, Coronary artery bypass surgery, Stroke, Transfusion, Aged, Cardiopulmonary Bypass, Coronary Artery Bypass, Female, Hemorrhage, Heparin, Humans, Male, Middle Aged, Postoperative Hemorrhage, Prospective Studies, Registries, Risk Factors, Stroke ,Perioperative ,medicine.disease ,Prospective Studie ,030228 respiratory system ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,business - Abstract
International audience; INTRODUCTION: This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery.METHODS: This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions.RESULTS: Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding.CONCLUSIONS: Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
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- 2016
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