VTE Risk Raised By Certain Blood Transfusions

Perioperative red blood cell (RBC) transfusions may be significantly associated with postoperative venous thromboembolism (VTE) risk, according to new findings.

Researchers arrived at this conclusion following a study of 750,937 patients aged 44 to 69 years who underwent surgery in 2014. Data were obtained from the American College of Surgery National Surgical Quality Improvement Program database.


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Multivariable logistic regression was used to estimate risk-adjusted odds ratios (aORs).

A total of 47,410 (6.3%) patients received at least 1 perioperative RBC transfusion. Ultimately, 6309 (0.8%) patients developed postoperative VTE—defined as the development of deep venous thrombosis (DVT; n = 4336), pulmonary embolism (PE; n = 2514), or both (n = 541) within 30 days of surgery.

These findings suggested an association between perioperative RBC transfusion and the risk for VTE (aOR 2.1), DVT (aOR 2.2), and PE (aOR 1.9), independent of various putative risk factors.

The researchers observed a significant dose-response effect in this relationship. A higher number of perioperative and/or postoperative RBC transfusion events was found to be associated with a higher risk for VTE. aORs for 1, 2, and at least 3 events were 2.1, 3.1, and 4.5, respectively, compared with no perioperative or postoperative RBC transfusion.

According to findings from further subgroup analyses, this association was statistically significant for all surgical subspecialties that were studied, including general, cardiothoracic, gynecologic, neurologic, orthopedic, otolaryngologic, plastic, thoracic, urologic, and vascular surgery, as well as interventional radiology.

“These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices,” the researchers concluded.

—Christina Vogt


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