title: Red blood cell transfusion increases the risk of thrombotic events in patients with subarachnoid hemorrhage.
abstract: OBJECTIVE
  Red blood cell transfusion (RBCT) may increase the risk of thrombotic events (TE) in patients with subarachnoid hemorrhage (SAH) through changes induced by storage coupled with SAH-related hypercoagulability. We sought to investigate the association between RBCT and the risk of TE in patients with SAH.
  
  
  METHODS
  205 consecutive patients with acute, aneurysmal SAH admitted to the neurovascular intensive care unit of a tertiary care, academic medical center between 3/2008 and 7/2009 were enrolled in a retrospective, observational cohort study. TE were defined as the composite of venous thromboembolism (VTE), myocardial infarction (MI), and cerebral infarction noted on brain CT scan. Secondary endpoints included the risk of VTE, poor outcome (modified Rankin score 3-6 at discharge), and in-hospital mortality.
  
  
  RESULTS
  86/205 (42 %) received RBCT. Eighty-eight (43 %) had a thrombotic complication. Forty (34 %) of 119 non-transfused and 48/86 (56 %) transfused patients had a TE (p = 0.002). In multivariate analysis, RBCT was associated with more TE by [OR 2.4; 95 % CI (1.2, 4.6); p = 0.01], VTE [OR 2.3; 95 % CI (1.0, 5.2); p = 0.04], and poor outcome [OR 5.0; 95 % CI (1.9, 12.8); p < 0.01]. The risk of TE increased by 55 % per unit transfused when controlling for univariate variables. Neither mean nor maximum age of blood was significantly associated with thrombotic risk.
  
  
  CONCLUSIONS
  RBCT is associated with an increased risk of TE and VTE in SAH patients. A dose-dependent relationship exists between number of units transfused and thrombosis. Age of blood does not appear to play a role.
authors: Department of Neurology, Hospital of the University of Pennsylvania, University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA, Monisha.Kumar@uphs.upenn.edu.
authors: Monisha A
authors: MA
authors: Kumar
authors: Torrey A
authors: TA
authors: Boland
authors: Mohamed
authors: M
authors: Baiou
authors: Michael
authors: M
authors: Moussouttas
authors: Jay H
authors: JH
authors: Herman
authors: Rodney D
authors: RD
authors: Bell
authors: Robert H
authors: RH
authors: Rosenwasser
authors: Scott E
authors: SE
authors: Kasner
authors: Valerie E
authors: VE
authors: Dechant
mesh_terms: D000208:Acute Disease; D000368:Aged; D002544:Cerebral Infarction / Q000209:etiology* / Q000401:mortality; D002985:Clinical Protocols; D017707:Erythrocyte Transfusion / Q000009:adverse effects* / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000134:cerebrospinal fluid / Q000150:complications / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D011859:Radiography; D012189:Retrospective Studies; D012306:Risk; D013345:Subarachnoid Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000209:etiology* / Q000401:mortality