Abstract
BACKGROUND - Hemorrhage is associated with ischemic complications in cardiac patients. The nature of this relationship in surgical patients is unknown. METHODS AND RESULTS - We examined the association between major perioperative hemorrhage and stroke or myocardial infarction among adults who underwent surgery from 2005 through 2009 at centers participating in the National Surgical Quality Improvement Program. We excluded patients with emergent, trauma-related, transplantation, cardiac, or neurological operations. Major hemorrhage was defined as bleeding necessitating transfusion of >4 U of packed red blood cells or whole blood. Stroke was defined as focal brain dysfunction lasting ≥24 hours from a vascular cause. A diagnosis of myocardial infarction required new ECG Q waves. Outcomes were assessed from surgery until 30 days afterward. Among 651 775 patients who underwent surgery, 5233 (0.80%) experienced major hemorrhage, 1575 (0.24%) developed Q-wave myocardial infarction, and 1321 (0.20%) suffered a stroke. In Cox proportional hazards analyses controlling for vascular risk factors, illness severity, and type of surgery, hemorrhage was independently associated with subsequent stroke (hazard ratio, 2.5; 95% confidence interval, 1.9-3.3) and subsequent Q-wave myocardial infarction (hazard ratio, 2.7; 95% confidence interval, 2.1-3.4). Interaction terms revealed no significant variation in these associations by age, sex, or type of surgery. Our results were robust across multiple sensitivity analyses. CONCLUSIONS - Major perioperative hemorrhage is associated with subsequent stroke and myocardial infarction in patients undergoing noncardiac, nonneurological surgery. This suggests the need for randomized trials to guide perioperative use of antiplatelet drugs, which affect the risk of both bleeding and vascular events.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 207-212 |
| Number of pages | 6 |
| Journal | Circulation |
| Volume | 126 |
| Issue number | 2 |
| DOIs | |
| State | Published - Jul 10 2012 |
| Externally published | Yes |
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Keywords
- hemorrhage
- myocardial infarction
- risk factors
- stroke
- surgery
ASJC Scopus subject areas
- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Cite this
Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction. / Kamel, Hooman; Johnston, S. Claiborne; Kirkham, John C.; Turner, Christopher G.; Kizer, Jorge; Devereux, Richard B.; Iadecola, Costantino.
In: Circulation, Vol. 126, No. 2, 10.07.2012, p. 207-212.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Association between major perioperative hemorrhage and stroke or Q-wave myocardial infarction
AU - Kamel, Hooman
AU - Johnston, S. Claiborne
AU - Kirkham, John C.
AU - Turner, Christopher G.
AU - Kizer, Jorge
AU - Devereux, Richard B.
AU - Iadecola, Costantino
PY - 2012/7/10
Y1 - 2012/7/10
N2 - BACKGROUND - Hemorrhage is associated with ischemic complications in cardiac patients. The nature of this relationship in surgical patients is unknown. METHODS AND RESULTS - We examined the association between major perioperative hemorrhage and stroke or myocardial infarction among adults who underwent surgery from 2005 through 2009 at centers participating in the National Surgical Quality Improvement Program. We excluded patients with emergent, trauma-related, transplantation, cardiac, or neurological operations. Major hemorrhage was defined as bleeding necessitating transfusion of >4 U of packed red blood cells or whole blood. Stroke was defined as focal brain dysfunction lasting ≥24 hours from a vascular cause. A diagnosis of myocardial infarction required new ECG Q waves. Outcomes were assessed from surgery until 30 days afterward. Among 651 775 patients who underwent surgery, 5233 (0.80%) experienced major hemorrhage, 1575 (0.24%) developed Q-wave myocardial infarction, and 1321 (0.20%) suffered a stroke. In Cox proportional hazards analyses controlling for vascular risk factors, illness severity, and type of surgery, hemorrhage was independently associated with subsequent stroke (hazard ratio, 2.5; 95% confidence interval, 1.9-3.3) and subsequent Q-wave myocardial infarction (hazard ratio, 2.7; 95% confidence interval, 2.1-3.4). Interaction terms revealed no significant variation in these associations by age, sex, or type of surgery. Our results were robust across multiple sensitivity analyses. CONCLUSIONS - Major perioperative hemorrhage is associated with subsequent stroke and myocardial infarction in patients undergoing noncardiac, nonneurological surgery. This suggests the need for randomized trials to guide perioperative use of antiplatelet drugs, which affect the risk of both bleeding and vascular events.
AB - BACKGROUND - Hemorrhage is associated with ischemic complications in cardiac patients. The nature of this relationship in surgical patients is unknown. METHODS AND RESULTS - We examined the association between major perioperative hemorrhage and stroke or myocardial infarction among adults who underwent surgery from 2005 through 2009 at centers participating in the National Surgical Quality Improvement Program. We excluded patients with emergent, trauma-related, transplantation, cardiac, or neurological operations. Major hemorrhage was defined as bleeding necessitating transfusion of >4 U of packed red blood cells or whole blood. Stroke was defined as focal brain dysfunction lasting ≥24 hours from a vascular cause. A diagnosis of myocardial infarction required new ECG Q waves. Outcomes were assessed from surgery until 30 days afterward. Among 651 775 patients who underwent surgery, 5233 (0.80%) experienced major hemorrhage, 1575 (0.24%) developed Q-wave myocardial infarction, and 1321 (0.20%) suffered a stroke. In Cox proportional hazards analyses controlling for vascular risk factors, illness severity, and type of surgery, hemorrhage was independently associated with subsequent stroke (hazard ratio, 2.5; 95% confidence interval, 1.9-3.3) and subsequent Q-wave myocardial infarction (hazard ratio, 2.7; 95% confidence interval, 2.1-3.4). Interaction terms revealed no significant variation in these associations by age, sex, or type of surgery. Our results were robust across multiple sensitivity analyses. CONCLUSIONS - Major perioperative hemorrhage is associated with subsequent stroke and myocardial infarction in patients undergoing noncardiac, nonneurological surgery. This suggests the need for randomized trials to guide perioperative use of antiplatelet drugs, which affect the risk of both bleeding and vascular events.
KW - hemorrhage
KW - myocardial infarction
KW - risk factors
KW - stroke
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=84863800238&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84863800238&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.112.094326
DO - 10.1161/CIRCULATIONAHA.112.094326
M3 - Article
C2 - 22679143
AN - SCOPUS:84863800238
VL - 126
SP - 207
EP - 212
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 2
ER -