Transfusions Linked to Venous, Arterial Thrombotic Events in Cancer Patients

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Transfusions Linked to Venous, Arterial Thrombotic Events in Cancer Patients

Authors: Laurie Barclay, MD, Désirée Lie, MD, MSEd

December 2, 2008 ­ In patients hospitalized with

cancer, red blood cell (RBC) and platelet

transfusions are associated with an increased

risk for venous and arterial thrombotic events,

according to the results of a retrospective

cohort study reported in the November 24 issue of

the Archives of Internal Medicine.

" Anemia is frequent in patients with cancer, but

there are concerns regarding treatment with

erythropoiesis-stimulating agents, " write Alok A.

Khorana, MD, from the University of Rochester in

Rochester, New York, and colleagues. " Blood

transfusions are commonly used as an alternative,

but with little data regarding outcomes. "

Using the discharge database of the University

HealthSystem Consortium, the investigators

examined the associations between transfusions

and venous thromboembolism, arterial

thromboembolism, and mortality rates in

hospitalized patients with cancer. The study

sample included 504,208 hospitalizations of

cancer patients at 60 US medical centers between 1995 and 2003.

Of the patients examined in this analysis, 70,542

(14.0%) received at least 1 RBC transfusion and

15,237 (3.0%) received at least 1 platelet

transfusion. Venous thromboembolism occurred in

7.2% of patients receiving RBC transfusions and

arterial thromboembolism in 5.2%. These rates

were significantly greater than the rates of 3.8%

and 3.1%, respectively, seen in patients who did

not receive transfusions (P < .001).

An increased risk for venous thromboembolism was

independently linked to RBC transfusion (odds

ratio [OR], 1.60; 95% confidence interval [CI],

1.53 - 1.67) and platelet transfusion (OR, 1.20;

95% CI, 1.11 - 1.29), based on multivariate

analysis. Similar results were seen with arterial

thromboembolism (OR for RBC transfusion, 1.53;

95% CI, 1.46 - 1.61; and OR for platelet

transfusion, 1.55; 95% CI, 1.40 - 1.71; P < .001

for each). Transfusions were also associated with

a higher risk for death during hospitalization

(OR for RBC transfusion, 1.34; 95% CI, 1.29 -

1.38; and OR for platelet transfusion, 2.40; 2.27 - 2.52; P < .001).

" Both RBC and platelet transfusions are

associated with increased risks of venous and

arterial thrombotic events and mortality in

hospitalized patients with cancer, " the study

authors write. " Further investigation is

necessary to determine whether this relationship is causal. "

Limitations of this study include reliance on

administrative coding; inability to identify

patients concomitantly receiving

erythropoiesis-stimulating agents as part of

outpatient therapy, which is a potential

confounding factor; lack of data regarding

compliance with appropriate thromboprophylaxis;

inability to determine the time of administration

of transfusion in relationship to the development

of thromboembolic events or to identify patients

admitted with venous thromboembolism who

subsequently needed transfusions; and the

possibility that anemia is a marker for

aggressive tumor biology, more intensive chemotherapy, or " sicker " patients.

" Controversy exists regarding the treatment of

anemia in cancer with ESAs

[erythropoiesis-stimulating agents] because of

potential adverse effects, including

thromboembolism and worsened survival, " the study

authors write. " Data presented herein suggest

caution in using transfusions as an alternative

to ESAs because these may carry a similar risk of

adverse thrombotic and survival outcomes. These

findings suggest that rigorous studies evaluating

the risks and benefits of blood transfusion in

patients with cancer are necessary. "

Arch Intern Med. 2008;168:2377-2381.

Clinical Context

Anemia is observed in 30% to 90% of patients with

cancer. Erythropoiesis-stimulating agents have

been restricted in their use because of the risk

for thromboembolic complications and reduced

survival, and RBC and platelet transfusions have

been used as an alternative, but their safety has not been well studied.

This is a retrospective cohort study of patients

in a large database from 60 US medical centers to

examine the association between RBC and platelet

transfusions and the risk for venous

thromboembolism, arterial thromboembolism, and

mortality in patients with cancer who were

admitted to the hospital between 1995 and 2003.

Study Highlights

* Included were discharge summaries of

patients admitted to hospitals that were accessed

via the University HealthSystem Consortium.

* Only data reporting RBC transfusions in at

least 2% of admissions and platelet transfusions

in at least 0.1% of admissions during every year

were included in the analysis.

* This represented the lowest quartile of all consortium medical centers.

* The International Classification of

Diseases, Ninth Revision, code classification was

used to identify cases of venous thromboembolism,

arterial thromboembolism, and treatment and cancer diagnoses.

* Patients with multiple hospitalizations

were identified, and only a single randomly

chosen hospitalization per patient was included.

* The study population consisted of 504,208

patients with cancer admitted to 60 US medical centers.

* More than one third were 65 years or older,

more than two thirds were white, 12.3% were black, and 4.6% were Hispanic.

* Venous thromboembolism occurred in 4.2%,

with 3.5% having deep vein thrombosis and 1.1% having pulmonary embolism.

* Arterial thromboembolism occurred in 3.3% of patients.

* Within the study population, 14.7% received

either packed RBCs or platelet transfusions.

* 14.0% received at least 1 RBC transfusion,

and 3.0% received at least 1 platelet transfusion.

* 2.3% received both RBC and platelet transfusions.

* 0.6% received autologous whole-blood or RBC transfusions.

* Venous thromboembolism occurred in 7.2%

receiving RBC transfusions only, 6.6% receiving

both RBC and platelet transfusions, and 6.4%

receiving platelet transfusions only.

* These rates were higher vs the 3.7% venous

thromboembolism rate and 3.0% arterial

thromboembolism rate in hospitalized patients who

did not receive transfusions.

* Rates of venous thromboembolism and

arterial thromboembolism were low in those who

received autologous transfusions.

* For venous thromboembolism, RBC transfusion

was associated with an OR of 1.60 and platelet

transfusions with an OR of 1.20.

* Other variables significantly associated

with venous thromboembolism were older age (> 65

years), female sex, use of chemotherapy, primary

cancer site, use of venous catheters, and comorbidities.

* For arterial thromboembolism, RBC use was

associated with an OR of 1.53 and platelet transfusion with an OR of 1.55.

* Other variables increasing the risk for

arterial thromboembolism were older age, male

sex, primary cancer site, use of venous catheters, and comorbidities.

* Death during hospitalization occurred in 33,924 patients (6.7%).

* The in-hospital mortality rate was higher

in those receiving RBC transfusions (11.9%) and platelet transfusions (23.1%).

* The in-hospital mortality rate was also

significantly higher for those with venous

thromboembolism (16.7%) and arterial thromboembolism (19.3%).

* RBC transfusions (OR, 1.34) and platelet

transfusions (OR, 2.40) were independently

associated with an increased risk for in-hospital

mortality after adjusting for variables.

* Other variables for mortality included

older age, primary site, nonwhite race, venous

thromboembolism, arterial thromboembolism, and the presence of comorbidities.

* The authors concluded that use of RBC or

platelet transfusions in patients with cancer was

associated with an increased risk for venous

thromboembolism, arterial thromboembolism, and in-hospital mortality.

Pearls for Practice

* Use of RBC and platelet transfusions in

patients with cancer is associated with an

increased risk for venous thromboembolism.

* Use of RBC and platelet transfusions in

patients with cancer is associated with an

increased risk for arterial thromboembolism and in-hospital mortality.

[Guest guest]

With this in mind.

For anyone that is needing surgery , please look into this!

Did you know you have A very good alternative to blood! and it is by far much

safer! And oh yeah!, CHEAPER! Thus many hospitals make so much off of blood they

rely on that instead. Many of the most up to date hospitals have access to this.

 

It is called 'cell saver' by many but here is the real name for it.

(Intraoperative Cell Salvage Machine)

 

Look into it before you have surgery, you may have to educate your Doctor or

bring him up to date.

 

Basically, when in surgery and you bleed, instead of letting you bleed and

putting someone Else's contaminated blood etc . in your system, they vacuum it

up and run it through a machine like a dialysis machine and put your own cleaned

blood right back into you.

 

http://www.haemonetics.com/site/content/products/cellsaver.asp

 

http://www.cts.usc.edu/zglossary-cellsaver.html

 

Dennis

Transfusions Linked to Venous, Arterial Thrombotic Events in Cancer Patients.

Authors: Laurie Barclay, MD, Désirée Lie, MD, MSEd

December 2, 2008 ­ In patients hospitalized with

cancer, red blood cell (RBC) and platelet

transfusions are associated with an increased

risk for venous and arterial thrombotic events,

according to the results of a retrospective

cohort study reported in the November 24 issue of

the Archives of Internal Medicine.....................<snip>