Intraoperative Plasma Transfusion Volumes and Outcomes in Cardiac Surgery

Mark M. Smith, Daryl J. Kor, Ryan D. Frank, Timothy J. Weister, Joseph A. Dearani, Matthew A. Warner

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Objective: Assess outcomes after intraoperative plasma transfusion in patients undergoing cardiac surgery. Design: Retrospective study of adult cardiac surgical between 2011 and 2015. Relationships between plasma transfusion volume, coagulation test values, and a primary outcome of early postoperative red blood cell (RBC) transfusion were assessed via multivariable regression analyses. Secondary outcomes included hospital mortality, intensive care unit and hospital-free days, intraoperative RBCs, estimated blood loss, and reoperation for bleeding. Setting: Academic tertiary referral center. Participants: A total of 1,794 patients received intraoperative plasma transfusions during the study period. Interventions: None. Measurements and Main Results: Higher plasma transfusion volumes were associated with worse clinical outcomes, with each 1-unit increase being associated with greater odds for postoperative RBCs [odds ratio (OR) 1.12 (confidence interval [CI] 1.04-1.20); p = 0.002], intraoperative [OR 1.85 (CI 1.69-2.03); p < 0.001], and fewer hospital-free days [mean –0.20 (–0.39, –0.01); p = 0.04]. Each 0.1 increase in pretransfusion International Normalized Ratio (INR) was associated with increased odds of postoperative and intraoperative RBCs, reoperation for bleeding, and fewer intensive care unit and hospital-free days. For given plasma volumes, patients achieving greater reduction in elevated pretransfusion INR values experienced more favorable outcomes. Conclusions: In patients undergoing cardiac surgery who received intraoperative plasma transfusion, higher plasma transfusion volumes were associated with inferior clinical outcomes. Higher pretransfusion INR values also were associated with worse outcomes; however, those achieving a greater degree of INR correction after plasma transfusion demonstrated more favorable outcomes. Prospective studies related to plasma transfusion are needed to address this important topic.

Original languageEnglish (US)
Pages (from-to)1446-1456
Number of pages11
JournalJournal of Cardiothoracic and Vascular Anesthesia
Issue number6
StatePublished - Jun 2020


  • INR
  • bleeding, transfusion
  • cardiac surgery
  • coagulation
  • plasma

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine


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