Blood transfusion during surgery boosts risk of venous thromboembolism

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Red blood cell (RBC) transfusions during surgery are associated with double the risk of venous thromboembolism (VTE) over the ensuing 30 days, researchers reported in JAMA Surgery.
Investigators analyzed more than 750,000 patients undergoing surgery from a registry containing 525 North American hospitals. A total of 6.3 percent of the patients received perioperative RBC transfusions, defined as a transfusion from 72 hours before to 72 hours after surgery.
These patients experienced VTE at a rate 2.1 times higher than those who didn’t undergo transfusions, even after adjustment for patient characteristics, surgical complexity and hospital length of stay. However, only 0.8 percent of patients in the study experienced postoperative VTE, a combination of pulmonary embolism and deep vein thrombosis.
“Transfused RBCs have been proposed to modulate the inflammatory cascade,” wrote lead author Ruchika Goel, MD, MPH, with New York Presbyterian Hospital and Weill Cornell Medicine, and colleagues. “In addition, during the storage period, RBCs develop storage lesions, including metabolic, biochemical, and physical changes responsible for the accumulation of bioreactive substances such as microparticles, which can have a prothrombogenic potential.
“Because inflammation and hypercoagulation are closely linked, the proinflammatory and immunomodulatory properties of RBC transfusion may further potentiate a hypercoagulable state.”

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