Table 3.
Associations with primary and secondary outcomes using multivariable regression stratified by preoperative INR
| Characteristic | Postoperative RBCs Odds Ratio (95% CI)† |
Hospital Mortality Odds Ratio (95% CI)† |
ICU Free Days Mean (95% CI)‡ |
Hospital Free Days Mean (95% CI)‡ |
Intraoperative RBCs§ Odds Ratio (95% CI)† |
Intraop RBC Units§ Mean (95% CI)‡ |
EBL (ml)§ Mean (95% CI)‡ |
|---|---|---|---|---|---|---|---|
| INR < 1.5 (n=743) | |||||||
| Plasma dose†† | 1.03 (1.01, 1.05) * | 1.03 (0.99, 1.07) | −0.10 (−0.17, −0.03)** | −0.17 (−0.24, −0.09)*** | 1.14 (1.11, 1.17)*** | 0.27 (0.25, 0.28)*** | 74 (65, 82)*** |
| Pre-transfusion INR†† | 5.30 (1.47, 19.08)* | 1.09 (0.09, 13.84) | −1.32 (−5.38, 2.73) | −1.43 (−5.73, 2.87) | 0.31 (0.08, 1.23) | 0.35 (−1.47, 2.17) | 152 (−798, 1102) |
| Pre-Post INR†† | 0.24 (0.11, 0.53)*** | 0.25 (0.07, 0.89)* | 5.33 (2.92, 7.75)*** | 5.65 (3.09, 8.21)*** | 0.35 (0.15, 0.82) * | −1.49 (−2.55, −0.43) ** | −758 (−1343, −173) * |
| Pre-transfusion R‡‡ | - | - | −0.22 (−0.45, 0.00) | −0.23 (−0.48, 0.02) | 1.11 (0.98, 1.25) | −0.02 (−0.14, 0.11) | −15 (−67, 37) |
| Pre-Post R‡‡ | - | - | −0.02 (−0.16, 0.11) | −0.02 (−0.17, 0.13) | 0.98 (0.92, 1.04) | 0.03 (−0.05, 0.11) | −7 (−38, 24) |
| 1.5 ≤ INR < 2 (n=1768) | |||||||
| Plasma dose†† | 1.03 (1.01, 1.05)*** | 1.01 (0.98, 1.04) | −0.08 (−0.13, −0.04)*** | −0.09 (−0.14, −0.04)*** | 1.18 (1.15, 1.21)*** | 0.18 (0.17, 0.19)*** | 69 (62, 76)*** |
| Pre-transfusion INR†† | 7.48 (2.79, 20.06)*** | 10.00 (1.41, 70.76)* | −1.58 (−4.00, 0.85) | −2.44 (−5.05, 0.18) | 1.02 (0.38, 2.72) | −0.05 (−0.73, 0.64) | 235 (−291, 760) |
| Pre-Post INR†† | 0.06 (0.03, 0.13)*** | 0.14 (0.04, 0.44)*** | 3.25 (1.51, 4.99)*** | 3.62 (1.74, 5.50)*** | 0.50 (0.25, 1.00) | −0.62 (−1.09, −0.15) * | −739 (−1103, −376)*** |
| Pre-transfusion R‡‡ | 1.01 (0.93, 1.10) | 0.91 (0.60, 1.38) | −0.08 (−0.30, 0.15) | −0.12 (−0.36, 0.13) | 0.96 (0.88, 1.05) | −0.06 (−0.12, −0.00) * | −37 (−86, 12) |
| Pre-Post INR‡‡ | 0.99 (0.93, 1.04) | 1.22 (0.82, 1.82) | −0.02 (−0.17, 0.13) | 0.06 (−0.10, 0.22) | 1.02 (0.96, 1.08) | 0.04 (−0.00, 0.08) | 47 (13, 80) ** |
| INR ≥ 2 (n=882) | |||||||
| Plasma dose†† | 1.02 (1.00, 1.04) | 1.01 (0.98, 1.04) | −0.08 (−0.14, −0.01) * | −0.04 (−0.10, 0.03) | 1.18 (1.15, 1.21)*** | 0.16 (0.15, 0.17)*** | 70 (61, 78)*** |
| Pre-transfusion INR†† | 1.78 (1.14, 2.80) * | 1.09 (0.49, 2.45) | 0.22 (−1.17, 1.60) | 1.22 (−0.20, 2.64) | 0.79 (0.48, 1.30) | −0.20 (−0.59, 0.19) | −214 (−550, 123) |
| Pre-Post INR†† | 0.51 (0.32, 0.81) ** | 0.87 (0.38, 1.99) | −0.27 (−1.67, 1.12) | −0.86 (−2.29, 0.56) | 1.12 (0.67, 1.88) | 0.02 (−0.38, 0.42) | 178 (−159, 514) |
| Pre-transfusion R‡‡ | 1.01 (0.89, 1.15) | - | −0.29 (−0.67, 0.09) | −0.27 (−0.61, 0.07) | 0.91 (0.78, 1.06) | −0.10 (−0.26, 0.06) | −59 (−167, 49) |
| Pre-Post R‡‡ | 1.00 (0.88, 1.13) | - | 0.21 (−0.16, 0.58) | 0.19 (−0.13, 0.51) | 1.08 (0.93, 1.26) | 0.11 (−0.04, 0.26) | 58 (−45, 162) |
Plasma dose is per 1 ml/kg. Change in INR and change in R-values were calculated as pre-transfusion – post-transfusion values.
Regression models include row covariate plus preoperative demographics (age, gender, body mass index), pre-operative laboratory values (creatinine, sodium, glucose, leukocyte count, hemoglobin, platelet count), preoperative medications (aspirin, clopidogrel, warfarin, NSAIDs, heparin or low-molecular weight heparin, vasopressors, inotropes within 24 hours of the procedure, insulin), preoperative platelet, plasma, and RBC transfusions, intraoperative transfusion volumes (plasma, platelets, allogeneic RBCs, cell-salvaged blood), total intraoperative crystalloid and colloid volumes, intraoperative factor concentrate administration (including prothrombin complex concentrates and single factor replacements), surgical features [surgery type, surgery length, anesthesia type (general, monitored anesthesia care, primary regional), emergency surgery, estimated blood loss], patient comorbidities (preoperative Charlson score, preoperative SOFA scores).
P < 0.05
P < 0.01
P < 0.001
Unable to analyze due to small event counts.
Analyzed using multivariable logistic regression.
Analyzed using multivariable linear regression.
Only preoperative characteristics were included when analyzing the outcomes of intraoperative RBCs, intraoperative RBC units, and estimated blood loss.
Regressions models additionally include plasma dose (per ml/kg), preoperative INR, and decrease in INR.
Regressions models additionally include plasma dose (per ml/kg), preoperative R, and decrease in R.