title: Bleeding, transfusion and the risk of stroke after coronary surgery: A prospective cohort study of 2357 patients.
abstract: BACKGROUND
  This study was planned to investigate the impact of severe bleeding and blood transfusion on the development of stroke after coronary surgery.
  
  
  METHODS
  This cohort study includes 2357 patients undergoing isolated CABG from the prospective European Coronary Artery Bypass Grafting (E-CABG) registry. Severity of bleeding was categorized according to the Universal Definition of Perioperative Bleeding (UDPB), E-CABG and PLATO definitions.
  
  
  RESULTS
  Thirty patients (1.3%) suffered postoperative stroke. The amount of transfused red blood cell (RBC) (OR 1.10, 95%CI 1.03-1.18), preoperative use of unfractioned heparin (OR 4.49, 95%CI 1.91-10.60), emergency operation (OR 3.97, 95%CI 1.47-10.74), diseased ascending aorta (OR 4.62, 95%CI 1.37-15.65) and use of cardiopulmonary bypass (p = 0.043, OR 4.85, 95%CI 1.05-22.36) were independent predictors of postoperative stroke. Adjusted analysis showed that UDPB classes 3-4 (crude rate: 3.6% vs. 1.0%; adjusted OR 2.66, 95%CI 1.05-6.73), E-CABG bleeding grades 2-3 (crudes rate: 6.3% vs. 0.9%; adjusted OR 5.91, 95%CI 2.43-14.36), and PLATO life-threatening bleeding (crude rate: 2.5% vs. 0.6%, adjusted OR 3.70, 95%CI 1.59-8.64) were associated with an increased risk of stroke compared with no or moderate bleeding.
  
  
  CONCLUSIONS
  Bleeding and blood transfusion are associated with an increased risk of stroke after CABG, which is highest in patients with severe bleeding.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Tauriainen
authors.affiliation: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perrotti
authors.affiliation: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Dalén
authors.affiliation: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Franzese
authors.affiliation: Department of Thoracic and Cardio-Vascular Surgery, University Hospital Jean Minjoz, Besançon, France.
authors.forename: Sidney
authors.initials: S
authors.lastname: Chocron
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Vito G
authors.initials: VG
authors.lastname: Ruggieri
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France.
authors.forename: Karl
authors.initials: K
authors.lastname: Bounader
authors.affiliation: Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Gulbins
authors.affiliation: Hamburg University Heart Center, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Reichart
authors.affiliation: Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery and Anesthesiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Svenarud
authors.affiliation: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santarpino
authors.affiliation: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Theodor
authors.initials: T
authors.lastname: Fischlein
authors.affiliation: Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany.
authors.forename: Tamas
authors.initials: T
authors.lastname: Puski
authors.affiliation: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Dominici
authors.affiliation: Department of Cardiac Surgery, St. Anna Hospital, Catanzaro, Italy.
authors.forename: Saverio
authors.initials: S
authors.lastname: Nardella
authors.affiliation: Department of Cardiovascular Sciences, Clinical Science Wing, University of Leicester, Glenfield Hospital, Leicester, UK.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.affiliation: Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gherli
authors.affiliation: Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Musumeci
authors.affiliation: Centro Cuore Morgagni, Pedara, Italy.
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.affiliation: Centro Cuore Morgagni, Pedara, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mignosa
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Division of Cardiac Surgery, Department of Cardiothoracic Sciences, Second University of Naples, Naples, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Bancone
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.affiliation: Division of Cardiac Surgery, Ospedali Riuniti, Trieste, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Maschietto
authors.affiliation: Division of Cardiac Surgery, University of Genoa, Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.affiliation: Division of Cardiac Surgery, University of Genoa, Genoa, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Salsano
authors.affiliation: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nicolini
authors.affiliation: Division of Cardiac Surgery, University of Parma, Parma, Italy.
authors.forename: Tiziano
authors.initials: T
authors.lastname: Gherli
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zanobini
authors.affiliation: Department of Cardiac Surgery, Centro Cardiologico-Fondazione Monzino IRCCS, University of Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Saccocci
authors.affiliation: National Institute for Health, Rome, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: D'Errigo
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Eeva-Maija
authors.initials: EM
authors.lastname: Kinnunen
authors.affiliation: Division of Cardiovascular Surgery, Verona University Hospital, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006470:Hemorrhage / Q000150:complications*; D006493:Heparin; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000150:complications*; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D020521:Stroke / Q000209:etiology*
chemical_list: D006493:Heparin
keywords: Bleeding; Cardiac surgery; Coronary artery bypass grafting; Coronary artery bypass surgery; Stroke; Transfusion