Addressing VTE Risk in Perioperative Blood Transfusions: A Q&A With Dr Ruchika Goel
Red blood cell (RBC) transfusions are often lifesaving procedures and frequently play a role in surgery. However, like many medical procedures, they are accompanied by risks for various complications, such as venous thromboembolism (VTE).
Recently, findings from a new study demonstrated that perioperative RBC transfusions may play a significant role in the risk for postoperative venous thromboembolism (VTE).
These findings have implications for perioperative blood management practices, since approximately two-thirds of hospital-acquired VTE cases can likely be prevented, said lead study author Ruchika Goel, MD, MPH, assistant professor of pathology, laboratory medicine, and pediatrics at Weill Cornell Medical College in New York City.
Consultant360 spoke with Dr Goel about her study and what needs to be done to minimize VTE risk following perioperative RBC transfusions.
Consultant360: What role do RBC transfusions play during surgery, and how often are they needed?
Ruchika Goel: RBC transfusions are needed frequently during surgery. The need for RBC transfusions can depend on the complexity of the surgery and blood loss during surgery, as well as pre-operative hemoglobin. Surgical patients with uncorrected pre-operative anemia and low hemoglobin tend to reach a threshold for transfusion during or after surgery much more often than those with pre-operative anemia that is appropriately addressed and corrected.
C360: Your study found that patients who received at least 1 RBC transfusion during surgery had an increased risk of VTE following surgery. What factors contributed to this risk, and can they be prevented?
RG: Increasing molecular and clinical evidence supports the role of RBCs in normal clotting, as well as abnormal thrombus formation. There are multiple possible mechanistic pathways linking RBC transfusions to an increased risk of VTE. These mechanisms been investigated in various studies over the past many years, but none have been established.
Largely, all proposed pathways suggest that transfused RBCs modulate the inflammatory cascade. As inflammation and hypercoagulation are closely linked, RBC transfusion may further potentiate this risk in patients who are also at risk for hypercoagulation or clot formation.
C360: What do you hope clinicians learn from your study? What needs to be done about perioperative blood transfusion practices to improve the VTE risk?
RG: We need to follow rigorous perioperative patient blood management practices. There is a need to correct pre-operative anemia using non-transfusion alternatives whenever possible. During surgery, transfusion decisions need to be stringent, and transfusions should only be used when really needed.
C360: What is the next step in your research?
RG: We are currently performing analyses to determine whether a similar relationship exists among pediatric and neonatal populations. Currently, there is very limited evidence-based guidance for transfusion practices in children and neonates.
For our coverage of Dr Goel’s study, click here.
Goel R, Paten EU, Cushing MM, et al. Association of perioperative red blood cell transfusions with venous thromboembolism in a North American registry [Published online June 13, 2018]. JAMA Surg. doi:10.1001/jamasurg.2018.1565