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Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials

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Kolin, David A, Shakura-Still, Haleema, Bello, Adenike, Chaudhri, Rizwana, Bates, Imelda ORCID: https://orcid.org/0000-0002-0862-8199 and Roberts, Ian (2020) 'Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials'. PLoS ONE, Vol 15, Issue 6, e0233274.

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Abstract

Background
Hemorrhage is a leading cause of death after trauma and childbirth. In response to severe hemorrhage, bleeding patients often receive transfusions of red blood cells, plasma, platelets, or other blood components. We examined risk factors for transfusion in acute severe
bleeding in two trials of over 20,000 patients to better understand factors associated with transfusion likelihood.
Study design and methods
We conducted a cohort analysis of data from the CRASH-2 and WOMAN trials, two multinational trials that recruited patients with traumatic and postpartum hemorrhage, respectively. For each trial, we examined the effect of 10 factors on blood transfusion likelihood. Univariate and multivariate Poisson regressions were used to analyze the relationship between risk factors and blood transfusion.
Results
Of the 20,207 traumatic hemorrhage patients, 10,232 (51%) received blood components. Of the 20,060 women with postpartum hemorrhage, 10,958 (55%) received blood components.
For patients who suffered from traumatic hemorrhage, those greater than three hours from injury to hospitalization were more likely to be transfused (ARR 1.37; 95% CI, 1.20–1.56).
Postpartum hemorrhage patients had an increased likelihood of transfusion if they gave birth outside the hospital (ARR 1.30; 95% CI 1.22–1.39), gave birth more than three hours
before hospitalization (ARR 1.09; 95% CI 1.01–1.17), had a Caesarean section (ARR 1.16; 95% CI 1.08–1.25), and if they had any identifiable causes of hemorrhage other than uterine atony
Conclusion
Several risk factors are associated with an increased likelihood of transfusion in traumatic and postpartum hemorrhage patients. Altering modifiable factors, by reducing time from injury or childbirth to hospitalization, for example, might be able to reduce transfusions and
their complications

Item Type: Article
Subjects: WB Practice of Medicine > Therapeutics > WB 356 Blood transfusion
WH Hemic and Lymphatic Systems > WH 100 General works
WQ Obstetrics > Pregnancy Complications > WQ 240 Pregnancy complications (General)
WQ Obstetrics > Pregnancy Complications > WQ 252 Hematologic complications
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pone.0233274
Depositing User: Tina Bowers
Date Deposited: 05 Jun 2020 09:08
Last Modified: 05 Jun 2020 09:08
URI: https://archive.lstmed.ac.uk/id/eprint/14633

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