The American Heart Association has issued a scientific statement in its journal Circulation on the topic of perioperative anemia and patient blood management in cardiac surgery.
Calling perioperative anemia and red blood cell transfusions important risk factors for morbidity and mortality in cardiac surgery, it notes that up to 50% of patients present for cardiac surgery affected by preoperative anemia. It states that iron deficiency, “the most common and potentially modifiable cause of preoperative anemia,” is a major driver of blood transfusions in cardiac surgery, which adversely affects both patient outcomes and resource utilization. As such, it calls for strategies that “aim to reduce blood loss and transfusions and improve patient outcomes.”
The association calls perioperative blood management “a patient-centered approach to blood conservation during cardiac surgery” that requires a “multidisciplinary collaborative effort among anesthesiologists, surgeons, perfusionists, intensivists, and transfusion laboratory teams.”
The scientific statement goes on to highlight the latest evidence generated by a “recent increase in research related to anemia, iron deficiency, and patient blood management in cardiac surgery,” including preoperative anemia assessment and intraoperative blood conservation. It discusses considerations for specific patient populations regarding anemia prevalence, treatment, and outcomes. It reviews “key challenges and knowledge gaps, with the goal of minimizing the impact of preoperative anemia, intraoperative blood loss, and hemodilution on cardiac surgery outcomes.”
Among the scientific statement’s conclusions:
- “It is imperative that anemia be diagnosed as early as possible in the preoperative course to allow time for adequate anemia treatment and hemoglobin optimization.”
- “Comprehensive patient blood management programs that focus on the avoidance of perioperative anemia at all stages, reduced intraoperative bleeding, and transfusion prevention may improve postoperative outcomes.”
- “Blood management programs are best implemented through multidisciplinary care teams and with hospital support that can be acquired through joint recognition that perioperative anemia treatment and blood conservation strategies improve outcomes and reduce resource utilization at both the local and national health care system level.”
It states that additional research is needed regarding the following “knowledge gaps”:
- Although it is well-documented that anemia and red blood cell transfusions negatively affect postoperative outcomes, it remains unknown “whether anemia and transfusions are in fact causative of these adverse outcomes.”
- Studies evaluating the effects of preoperative anemia treatment have demonstrated that pharmacologic therapies such as intravenous or oral iron and erythropoiesis-stimulating agents have been shown to increase preoperative hemoglobin and reduce intraoperative and postoperative red blood cell transfusions significantly in patients undergoing cardiac surgery, but the trials have yet to demonstrate an improvement in postoperative morbidity and mortality with these therapies.
- Noting that the prevalence of perioperative anemia varies according to age, sex, race, and socioeconomic status, “more research is needed in more diverse patient populations to better understand the mechanisms of these differences and how to best improve outcomes in various patient populations.” The majority of published literature investigating the relationship between perioperative anemia and outcomes “is based on clinical data from largely male and White patient populations.”
- “Future areas for research and clinical programmatic development may include more personalized preoperative care plans to determine which patients may benefit the most from individual components of comprehensive blood management strategies and better identification of patients at risk for anemia using artificial intelligence and electronic medical record information.”
Read the association’s full scientific statement here.
