FREQUENCY, PREDICTORS, AND APPROPRIATENESS OF BLOOD-TRANSFUSION AFTERPERCUTANEOUS CORONARY INTERVENTIONS

Increased awareness of the risks of blood-borne infections has recentl y led to profound changes in the practice of transfusion medicine. The se changes include, among others, the development of guidelines by the American College of Physicians (ACP) for transfusion. Although the in cidence and predictors of vascular complications of percutaneous inter ventions have been well defined, there are currently no data on freque ncy, risk factors, and appropriateness of blood transfusions. We perfo rmed a retrospective analysis of 628 consecutive percutaneous coronary revascularization procedures. Predictors of blood transfusion were id entified using multivariate logistic regression analysis. Appropriaten ess of transfusions was determined using modified ACP guidelines. Tran sfusions were administered after 8.9% of interventions (56 of 628). Mu ltivariate analysis identified age >70 years, female gender, procedure duration, coronary stenting, acute myocardial infarction, postprocedu ral use of heparin and intra-aortic balloon pump placement as independ ent predictors of blood transfusions (all p <0.05). According to the A CP guidelines, 36 of 56 patients (64%) received transfusions inappropr iately. Transfusion reactions (fever) occurred in 10% of patients who received tranfusions appropriately and in 5% of patients who received tranfusions inappropriately. The estimated additional costs per proced ure related to transfusions were $551 and $419, respectively. In concl usion, unnecessary transfusions were performed frequently after percut aneous coronary interventions. Application of available guidelines cou ld reduce the number of unnecessary transfusions thus avoiding exposur e of patients to additional risks and reducing procedural costs. (C) 1 998 by Excerpta Medico, Inc.