Association between isolated abnormal coagulation profile on transfusion following major surgery: A NSQIP analysis of individuals without bleeding disorders

• Published in: Transfusion (Philadelphia, Pa.) Pa.), 2022-11, Vol.62 (11), p.2223-2234
• Main Authors: Lim, Kelvin, Satkunasivam, Raj, Nipper, Cole, Xu, Jiaqiong, Hsu, Enshuo, Slawin, Jeremy R., Roy, Trisha, Allenson, Kelvin C., Kim, Min P., Barber, Sean M., Ellis, Taryn, Akinsola, Olutiwa, Klaassen, Zachary, Esnaola, Nestor, Ravi, Bheeshma, Jerath, Angela, Wallis, Christopher J. D.
• Format: Article
• Language: English
• Subjects: Abnormalities; aPTT; Bleeding; Blood Coagulation Disorders - complications; Blood Coagulation Disorders - therapy; Blood Transfusion; Coagulation; Combinatorial analysis; Disorders; Erythrocytes; Hemophilia; Hemorrhage - etiology; Humans; INR; NSQIP; Partial Thromboplastin Time; Patients; platelet; Postoperative Complications - etiology; Quality control; Quality Improvement; Retrospective Studies; Risk; Surgery; Synergistic effect; Transfusion
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.17146

Introduction Preoperative coagulation screening for patients without bleeding disorders remains controversial. The combinatorial risk of INR, aPTT, and platelet count (PLT) abnormalities leading to bleeding requiring transfusion is not known in these patients. We examined the association between abnormal coagulation profile and the risk of transfusion following common elective surgery in patients without bleeding disorders. Study Design and Methods We utilized the National Surgical Quality Improvement Program (NSQIP) database from 2004 to 2018 to identify patients without a history of bleeding disorders undergoing common 23 major elective procedures across 10 specialties. Multivariable logistic regression was used to assess the association between coagulation profile and bleeding requiring packed red blood cell transfusion intra−/post‐operatively. Results Of the 672,075 patients meeting inclusion criteria, 53.7% presented with normal coagulation profile preoperatively. Overall, 12.2% (n = 82,368) received transfusion. In the setting of normal aPTT/PLT, both Equivocal INR of 1.1–1.5 (aOR 1.41, 95% CI 1.38–1.44) and Abnormal INR of >1.5 (aOR 1.81, 95% CI 1.71–1.93) were significantly associated with an increased risk of transfusion. Equivocal (60–70) and Abnormal (>70) aPTT with normal INR/PLT did not demonstrate a comparable risk of transfusion. We observed a synergistic effect of combinatorial lab abnormalities on the risk of transfusion when both Abnormal INR/aPTT and Low PLT of