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Table 2 Adult studies assessing the association between transfusion and the development of perioperative stroke or cognitive dysfunction among patients undergoing cardiac surgery

From: Anemia and red blood cell transfusion in neurocritical care

Study

Patients

Design and setting

Multivariable analysis

Exposure

Outcome

Main result

Brevig and colleagues [117]

2531

Retrospective (prospective database)

Single-center

None

Any blood product transfusion

Postoperative CVA (not further defined)

Despite reduction in proportion of patients transfused over time (43% in 2003 vs. 18% in 2007), no change in proportion of patients with CVA (0.8 to 1.5%)

Ngaage and colleagues [118]

383 (≥80 years old)

Retrospective (prospective database)

Single-center

Logistic regression

Any blood product transfusion

Neurologic complications (confusion/agitation, seizures, TIA, RIND, stroke, or coma)

Transfusion associated with neurologic complications (OR = 3.6 vs. no transfusion, P = 0.003)

Murphy and colleagues [119]

8518

Retrospective

Single-center

Logistic regression and propensity scores

Any perioperative RBC transfusion

Composite of MI, stroke (permanent or transient), or renal failure

RBC transfusion was associated with composite outcome (OR = 3.35 for transfusion vs. no transfusion; P < 0.0001)

Whitson and colleagues [120]

2691

Retrospective (prospective database)

Single-center

Logistic regression

Any RBC transfusion

CVA (not further defined)

RBC transfusion was associated with CVA (OR = 1.7, P = 0.01)

Norkiene and colleagues [121]

1367

Retrospective

Single-center

Logistic regression

Any RBC transfusion

Delirium (DSM-IV criteria)

Postoperative RBC transfusion was associated with delirium (OR = 4.6, P < 0.001)

Koch and colleagues [122]

11,963 (CABG)

Retrospective (prospective database)

Single-center

Logistic regression

Total number of units of RBCs transfused

Focal or global neurologic deficits or death without awakening

RBC transfusion was associated with stroke (OR = 1.73 for each unit RBCs; P < 0.0001)

Stamou and colleagues [123]

49 JW patients

Retrospective

Single-center

196 controls

Logistic regression and propensity scores

Any RBC transfusion

Nadir Hb not reported

Perioperative stroke

No statistically significant difference in risk of stroke between JWs refusing RBCs and transfused control patients

Karkouti and colleagues [105]

10,949

Retrospective (prospective database)

Single-center

Logistic regression

Total number of units of blood product

New perioperative persistent postoperative neurological deficit

Transfusion was associated with stroke (OR = 1.02 for each unit RBCs; P = 0.01)

Bucerius and colleagues [124]

16,184

Retrospective (prospective database)

Single-center

Logistic regression

Any perioperative RBC transfusion

Temporary or permanent focal or global neurologic deficit

'High transfusion requirement' ((≥1000 ml) was associated with stroke (OR = 6.04; P < 0.0001)

D'Ancona and colleagues [125]

9916 (CABG)

Retrospective (prospective database)

Single-center

Logistic regression

Any blood product transfusion

New temporary or permanent, focal or global neurologic deficit

Transfusion was associated with stroke (OR = 1.59 vs. no transfusion; P = 0.002)

  1. CABG = coronary artery bypass grafting; CVA = cerebrovascular accident; Hb = hemoglobin; JW = Jehovah's Witness; MI = myocardial infarction; OR = odds ratio; RBC = red blood cell; RIND = reversible ischemic neurologic deficit; TIA = transient ischemic attack.