title: Risk factors related to transfusion requirements in patients undergoing implantation of ventricular assist devices.
abstract: OBJECTIVE
  The identification of transfusion risk factors in patients receiving left ventricular assist devices to allow for targeted use of blood conservation strategies and improved blood utilization.
  
  
  METHODS
  This is a retrospective analysis of prospectively collected data between April 2009 and June 2012. Linear regression was used to determine factors associated with increased transfusion. Logistic regression was used to determine factors that were associated with more than the median number of units transfused.
  
  
  METHODS
  Single center, university hospital.
  
  
  METHODS
  Patients (n=144) who underwent left ventricular assist device implantation.
  
  
  METHODS
  Transfused blood product data for the day of surgery and for 3 days after were obtained from the blood bank.
  
  
  RESULTS
  Beta-blockers were associated with 1.7±0.65 fewer red blood cell (RBC) units and 2.2±0.7 fewer fresh frozen plasma units transfused. Each year of older age was associated with 0.113±0.023 units of RBC, 0.543±0.101 platelet, and 0.098±0.017 plasma units transfused. International normalized ratio was associated with more platelet transfusion (20.813±5.757 units per 1.0 increase), but not with plasma or RBC transfusion. Lower platelet counts were associated with both platelet (-0.045±0.019 units per 10,000 μL(-1)) and plasma transfusions (-0.011±0.004). Myocardial infarction was associated with increased RBC and plasma transfusion, and cardiogenic shock was associated with increased platelet transfusions, but nitrate use was associated with reduced platelet transfusion.
  
  
  CONCLUSIONS
  Beta-blockers may be a modifiable factor to decrease transfusions. The association between international normalized ratio and platelet transfusions suggests that better determination of the type of coagulopathy may promote more appropriate transfusions.
authors.affiliation: Departments of *Anesthesiology. Electronic address: seanneil@med.umich.edu.
authors.forename: Sean
authors.initials: S
authors.lastname: Neill
authors.affiliation: Departments of *Anesthesiology.
authors.forename: Milo
authors.initials: M
authors.lastname: Engoren
authors.affiliation: Departments of *Anesthesiology.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Kouatli
authors.affiliation: Departments of *Anesthesiology.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Shields
authors.affiliation: Departments of *Anesthesiology.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Jewell
authors.affiliation: Cardiac Surgery, University of Michigan, Ann Arbor, MI.
authors.forename: Francis D
authors.initials: FD
authors.lastname: Pagani
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: VADs; bleeding; circulatory assist devices; transfusion; ventricular assist devices