Risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YU Jintian ¹ , CHEN Junshan ¹ ,  ZHANG Aiqin ²

1. Department of Intensive Care Unit, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;
2. The Outpatient Department, Jinling Hospital Affiliated to Medical College of Nanjing University (Eastern Theater General Hospital), Nanjing, 210002, P.R.China;

Corresponding?author：

ZHANG Aiqin, Email: aq09z@126.com

Keywords：

Coronary artery bypass grafting; perioperative period; blood transfusion; risk factors; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202004063

Video：

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Objective To systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG).Methods PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software.Results A total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG.Conclusion Current evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.

Citation： YU Jintian, CHEN Junshan, ZHANG Aiqin. Risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(11): 1332-1340. doi: 10.7507/1007-4848.202004063 Copy

1.	Ranucci M, Baryshnikova E, Castelvecchio S, et al. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg, 2013, 96(2): 478-485.
2.	Karlsson M, Ternstr?m L, Hyllner M, et al. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion, 2008, 48(10): 2152-2158.
3.	Mazlan AM, Ayob Y, Hussein AR, et al. Factors influencing transfusion requirement in patients undergoing first-time, elective coronary artery bypass graft surgery. Asian J Transfus Sci, 2017, 11(2): 95-101.
4.	Likosky DS, Paone G, Zhang M, et al. Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting surgery. Ann Thorac Surg, 2015, 100(3): 794-801.
5.	Kinnunen EM, Zanobini M, Onorati F, et al. The impact of minor blood transfusion on the outcome after coronary artery bypass grafting. J Crit Care, 2017, 8(40): 207-212.
6.	劉劍州, 張超紀, 李曉鳳, 等. 圍手術期輸注紅細胞影響冠心病術后療效的 Meta 分析. 中華胸心血管外科雜志, 2015, 31(7): 401-406.
7.	Tantawy H, Li A, Dai F, et al. Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2018, 32(3): 1225-1232.
8.	王現強, 孫志強, 高華煒, 等. 輸血對冠狀動脈旁路移植術患者預后的影響. 中國輸血雜志, 2017, 30(12): 1353-1356.
9.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
10.	Tuman KJ, McCarthy RJ, Christopher J, et al. Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery. Anesth Analg, 1996, 83: 1178-1184.
11.	Magovern JA, Sakert T, Benckart DH, et al. A model for predicting transfusion after coronary artery bypass grafting. Ann Thorac Surg, 1996, 61(1): 27-32.
12.	Shevde K, Pagala M, Kashikar A, et al. Gender is an essential determinant of blood transfusion in patients undergoing coronary artery bypass graft procedure. J Clin Anesth, 2000, 12(2): 109-116.
13.	Karkouti K, Cohen MM, McCluskey SA, et al. A multivariable model for predicting the need for blood transfusion in patients undergoing first-time elective coronary bypass graft surgery. Transfusion, 2001, 41(10): 1193-1203.
14.	Isomatsu Y, Tsukui H, Hoshino S, et al. Predicting blood transfusion factors in coronary artery bypass surgery. Jpn J Thorac Cardiovasc Surg, 2001, 49(7): 438-442.
15.	Scott BH, Seifert FC, Glass PS, et al. Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Anesth Analg, 2003, 97(4): 958-963.
16.	Litmathe J, Boeken U, Feindt P, et al. Predictors of homologous blood transfusion for patients undergoing open heart surgery. Thorac Cardiovasc Surg, 2003, 51(1): 17-21.
17.	Arora RC, Légaré JF, Buth KJ, et al. Identifying patients at risk of intraoperative and postoperative transfusion in isolated CABG: toward selective conservation strategies. Ann Thorac Surg, 2004, 78(5): 1547-1554.
18.	Gerli C, Mantovani L, Franco A, et al. Redo coronary artery bypass grafting on the beating heart and transfusion needs. Minerva Anestesiol, 2006, 72(12): 985-993.
19.	Maltais S, Perrault LP, Do QB. Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery. Eur J Cardiothorac Surg, 2008, 34(1): 127-131.
20.	Shoukat S, Gowani SA, Khimani F, et al. Predictive model of blood transfusion during CABG surgery in Pakistan. J Pak Med Assoc, 2008, 58(8): 421-426.
21.	Elmistekawy EM, Errett L, Fawzy HF. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting--the experience of a single cardiac center: a prospective observational study. J Cardiothorac Surg, 2009, 4: 20.
22.	van Straten AH, Kats S, Bekker MW, et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2010, 24(3): 413-417.
23.	Kwak YL, Kim JC, Choi YS, et al. Clopidogrel responsiveness regardless of the discontinuation date predicts increased blood loss and transfusion requirement after off-pump coronary artery bypass graft surgery. J Am Coll Cardiol, 2010, 56(24): 1994-2002.
24.	Williams ML, Trivedi JR, Doughtie C, et al. Is female sex an independent risk factor for perioperative transfusion in coronary artery bypass graft surgery? J Am Coll Surg, 2011, 212(3): 362-366.
25.	吳慧, 胡盛壽, 鄭哲, 等. 單純冠狀動脈旁路移植術患者圍術期輸血的危險因素分析. 中國輸血雜志, 2012, 25(4): 336-340.
26.	Nanjappa A, Gill J, Sadat U, et al. The effect of retrograde autologous priming on intraoperative blood product transfusion in coronary artery bypass grafting. Perfusion, 2013, 28(6): 530-535.
27.	De Santo LS, Amarelli C, Della Corte A, et al. Blood transfusion after on-pump coronary artery bypass grafting: focus on modifiable risk factors. Eur J Cardiothorac Surg, 2013, 43(2): 359-366.
28.	Jy W, Gómez-Marín O, Salerno TA, et al. Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2015, 149(1): 305-311.
29.	陳良, 呂琳, 龍村, 等. 冠狀動脈旁路移植術患者圍手術期紅細胞輸血的危險因素評估. 中國胸心血管外科臨床雜志, 2016, 23(7): 653-657.
30.	Stammers AH, Tesdahl EA, Mongero LB, et al. Gender and intraoperative blood transfusion: analysis of 54, 122 non-reoperative coronary revascularization procedures. Perfusion, 2019, 34(3): 236-245.
31.	張萬程, 王圣, 孫俊杰, 等. 非體外循環冠狀動脈旁路移植術圍術期紅細胞輸血危險因素分析. 中國循環雜志, 2019, 34(1): 61-65.
32.	Kitahara H, McCrorey M, Patel B, et al. Predictors of blood transfusion use in robotic beating-heart totally endoscopic coronary artery bypass with anastomotic connectors. J Card Surg, 2019, 34(9): 814-820.
33.	Chatterton S, Dignan R, Luu Q, et al. Platelet activity measured by VerifyNow? aspirin sensitivity test identifies coronary artery bypass surgery patients at increased risk for postoperative bleeding and transfusion. Heart Lung Circ, 2020, 29(3): 460-468.
34.	張萬程, 魯顯慧, 孫俊杰, 等. 體外循環冠狀動脈搭橋術圍術期大量輸注紅細胞的危險因素分析. 中國輸血雜志, 2018, 31(10): 1145-1148.
35.	董碧蓉. 老年衰弱綜合征的研究進展. 中華保健醫學雜志, 2014, 16(6): 417-420.
36.	Westerman S, Wenger NK. Women and heart diseases, the under recognized burden: sex differences, biases, and unmet clinical and research challenges. Clin Sci (Lond), 2016, 130(8): 551-563.
37.	張健瑜, 梁茜, 許兆延. 冠狀動脈微循環障礙的研究現狀及性別差異. 中國動脈硬化雜志, 2017, 25(8): 850-855.
38.	Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 2007, 298(17): 2028-2037.
39.	Zhang W, Chen S, Liu X, et al. Can higher body mass index patients save blood following on-pump coronary artery bypass grafting? Heart Surg Forum, 2019, 22(5): E352-E356.352-356.
40.	Lee BR, Song JW, Kwak YL, et al. The influence of hypothermia on transfusion requirement in patients who received clopidogrel in proximity to off-pump coronary bypass surgery. Yonsei Med J, 2014, 55(1): 224-231.
41.	Malenica M, Prnjavorac B, Bego T, et al. Effect of cigarette smoking on haematological parameters in healthy population. Med Arch, 2017, 71(2): 132-136.
42.	Neam?u MC, Cr?i?oiu ?, Avramescu ET, et al. The prevalence of the red cell morphology changes in patients with type 2 diabetes mellitus. Rom J Morphol Embryol, 2015, 56(1): 183-189.
43.	Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg, 2014, 97(1): 87-93.
44.	Goudie R, Sterne JA, Verheyden V, et al. Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery. Br J Anaesth, 2015, 114(5): 757-766.
45.	張國棟, 程振國, 孫來廣. 長期口服阿司匹林的高血壓腦出血患者術前輸血的意義. 中國實用神經疾病雜志, 2017, 20(8): 118-119.
46.	Spiegelstein D, Holmes SD, Pritchard G, et al. Preoperative hematocrit as a predictor of perioperative morbidities following nonemergent coronary artery bypass surgery. J Card Surg, 2015, 30(1): 20-26.
47.	Yanagawa B, Rocha RV, Mazine A, et al. Hemoglobin optimization for coronary bypass: A 10-year Canadian multicenter experience. Ann Thorac Surg, 2019, 107(3): 711-717.
48.	Sá MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2011, 26(4): 552-558.
49.	周玉姣, 于坤. 體外循環紅細胞損傷的原因、表現及危害. 中國體外循環雜志, 2015, 13(1): 61-64.

1. Ranucci M, Baryshnikova E, Castelvecchio S, et al. Major bleeding, transfusions, and anemia: the deadly triad of cardiac surgery. Ann Thorac Surg, 2013, 96(2): 478-485.
2. Karlsson M, Ternstr?m L, Hyllner M, et al. Plasma fibrinogen level, bleeding, and transfusion after on-pump coronary artery bypass grafting surgery: a prospective observational study. Transfusion, 2008, 48(10): 2152-2158.
3. Mazlan AM, Ayob Y, Hussein AR, et al. Factors influencing transfusion requirement in patients undergoing first-time, elective coronary artery bypass graft surgery. Asian J Transfus Sci, 2017, 11(2): 95-101.
4. Likosky DS, Paone G, Zhang M, et al. Red blood cell transfusions impact pneumonia rates after coronary artery bypass grafting surgery. Ann Thorac Surg, 2015, 100(3): 794-801.
5. Kinnunen EM, Zanobini M, Onorati F, et al. The impact of minor blood transfusion on the outcome after coronary artery bypass grafting. J Crit Care, 2017, 8(40): 207-212.
6. 劉劍州, 張超紀, 李曉鳳, 等. 圍手術期輸注紅細胞影響冠心病術后療效的 Meta 分析. 中華胸心血管外科雜志, 2015, 31(7): 401-406.
7. Tantawy H, Li A, Dai F, et al. Association of red blood cell transfusion and short- and longer-term mortality after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2018, 32(3): 1225-1232.
8. 王現強, 孫志強, 高華煒, 等. 輸血對冠狀動脈旁路移植術患者預后的影響. 中國輸血雜志, 2017, 30(12): 1353-1356.
9. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
10. Tuman KJ, McCarthy RJ, Christopher J, et al. Aspirin does not increase allogeneic blood transfusion in reoperative coronary artery surgery. Anesth Analg, 1996, 83: 1178-1184.
11. Magovern JA, Sakert T, Benckart DH, et al. A model for predicting transfusion after coronary artery bypass grafting. Ann Thorac Surg, 1996, 61(1): 27-32.
12. Shevde K, Pagala M, Kashikar A, et al. Gender is an essential determinant of blood transfusion in patients undergoing coronary artery bypass graft procedure. J Clin Anesth, 2000, 12(2): 109-116.
13. Karkouti K, Cohen MM, McCluskey SA, et al. A multivariable model for predicting the need for blood transfusion in patients undergoing first-time elective coronary bypass graft surgery. Transfusion, 2001, 41(10): 1193-1203.
14. Isomatsu Y, Tsukui H, Hoshino S, et al. Predicting blood transfusion factors in coronary artery bypass surgery. Jpn J Thorac Cardiovasc Surg, 2001, 49(7): 438-442.
15. Scott BH, Seifert FC, Glass PS, et al. Blood use in patients undergoing coronary artery bypass surgery: impact of cardiopulmonary bypass pump, hematocrit, gender, age, and body weight. Anesth Analg, 2003, 97(4): 958-963.
16. Litmathe J, Boeken U, Feindt P, et al. Predictors of homologous blood transfusion for patients undergoing open heart surgery. Thorac Cardiovasc Surg, 2003, 51(1): 17-21.
17. Arora RC, Légaré JF, Buth KJ, et al. Identifying patients at risk of intraoperative and postoperative transfusion in isolated CABG: toward selective conservation strategies. Ann Thorac Surg, 2004, 78(5): 1547-1554.
18. Gerli C, Mantovani L, Franco A, et al. Redo coronary artery bypass grafting on the beating heart and transfusion needs. Minerva Anestesiol, 2006, 72(12): 985-993.
19. Maltais S, Perrault LP, Do QB. Effect of clopidogrel on bleeding and transfusions after off-pump coronary artery bypass graft surgery: impact of discontinuation prior to surgery. Eur J Cardiothorac Surg, 2008, 34(1): 127-131.
20. Shoukat S, Gowani SA, Khimani F, et al. Predictive model of blood transfusion during CABG surgery in Pakistan. J Pak Med Assoc, 2008, 58(8): 421-426.
21. Elmistekawy EM, Errett L, Fawzy HF. Predictors of packed red cell transfusion after isolated primary coronary artery bypass grafting--the experience of a single cardiac center: a prospective observational study. J Cardiothorac Surg, 2009, 4: 20.
22. van Straten AH, Kats S, Bekker MW, et al. Risk factors for red blood cell transfusion after coronary artery bypass graft surgery. J Cardiothorac Vasc Anesth, 2010, 24(3): 413-417.
23. Kwak YL, Kim JC, Choi YS, et al. Clopidogrel responsiveness regardless of the discontinuation date predicts increased blood loss and transfusion requirement after off-pump coronary artery bypass graft surgery. J Am Coll Cardiol, 2010, 56(24): 1994-2002.
24. Williams ML, Trivedi JR, Doughtie C, et al. Is female sex an independent risk factor for perioperative transfusion in coronary artery bypass graft surgery? J Am Coll Surg, 2011, 212(3): 362-366.
25. 吳慧, 胡盛壽, 鄭哲, 等. 單純冠狀動脈旁路移植術患者圍術期輸血的危險因素分析. 中國輸血雜志, 2012, 25(4): 336-340.
26. Nanjappa A, Gill J, Sadat U, et al. The effect of retrograde autologous priming on intraoperative blood product transfusion in coronary artery bypass grafting. Perfusion, 2013, 28(6): 530-535.
27. De Santo LS, Amarelli C, Della Corte A, et al. Blood transfusion after on-pump coronary artery bypass grafting: focus on modifiable risk factors. Eur J Cardiothorac Surg, 2013, 43(2): 359-366.
28. Jy W, Gómez-Marín O, Salerno TA, et al. Presurgical levels of circulating cell-derived microparticles discriminate between patients with and without transfusion in coronary artery bypass graft surgery. J Thorac Cardiovasc Surg, 2015, 149(1): 305-311.
29. 陳良, 呂琳, 龍村, 等. 冠狀動脈旁路移植術患者圍手術期紅細胞輸血的危險因素評估. 中國胸心血管外科臨床雜志, 2016, 23(7): 653-657.
30. Stammers AH, Tesdahl EA, Mongero LB, et al. Gender and intraoperative blood transfusion: analysis of 54, 122 non-reoperative coronary revascularization procedures. Perfusion, 2019, 34(3): 236-245.
31. 張萬程, 王圣, 孫俊杰, 等. 非體外循環冠狀動脈旁路移植術圍術期紅細胞輸血危險因素分析. 中國循環雜志, 2019, 34(1): 61-65.
32. Kitahara H, McCrorey M, Patel B, et al. Predictors of blood transfusion use in robotic beating-heart totally endoscopic coronary artery bypass with anastomotic connectors. J Card Surg, 2019, 34(9): 814-820.
33. Chatterton S, Dignan R, Luu Q, et al. Platelet activity measured by VerifyNow? aspirin sensitivity test identifies coronary artery bypass surgery patients at increased risk for postoperative bleeding and transfusion. Heart Lung Circ, 2020, 29(3): 460-468.
34. 張萬程, 魯顯慧, 孫俊杰, 等. 體外循環冠狀動脈搭橋術圍術期大量輸注紅細胞的危險因素分析. 中國輸血雜志, 2018, 31(10): 1145-1148.
35. 董碧蓉. 老年衰弱綜合征的研究進展. 中華保健醫學雜志, 2014, 16(6): 417-420.
36. Westerman S, Wenger NK. Women and heart diseases, the under recognized burden: sex differences, biases, and unmet clinical and research challenges. Clin Sci (Lond), 2016, 130(8): 551-563.
37. 張健瑜, 梁茜, 許兆延. 冠狀動脈微循環障礙的研究現狀及性別差異. 中國動脈硬化雜志, 2017, 25(8): 850-855.
38. Flegal KM, Graubard BI, Williamson DF, et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA, 2007, 298(17): 2028-2037.
39. Zhang W, Chen S, Liu X, et al. Can higher body mass index patients save blood following on-pump coronary artery bypass grafting? Heart Surg Forum, 2019, 22(5): E352-E356.352-356.
40. Lee BR, Song JW, Kwak YL, et al. The influence of hypothermia on transfusion requirement in patients who received clopidogrel in proximity to off-pump coronary bypass surgery. Yonsei Med J, 2014, 55(1): 224-231.
41. Malenica M, Prnjavorac B, Bego T, et al. Effect of cigarette smoking on haematological parameters in healthy population. Med Arch, 2017, 71(2): 132-136.
42. Neam?u MC, Cr?i?oiu ?, Avramescu ET, et al. The prevalence of the red cell morphology changes in patients with type 2 diabetes mellitus. Rom J Morphol Embryol, 2015, 56(1): 183-189.
43. Paone G, Likosky DS, Brewer R, et al. Transfusion of 1 and 2 units of red blood cells is associated with increased morbidity and mortality. Ann Thorac Surg, 2014, 97(1): 87-93.
44. Goudie R, Sterne JA, Verheyden V, et al. Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery. Br J Anaesth, 2015, 114(5): 757-766.
45. 張國棟, 程振國, 孫來廣. 長期口服阿司匹林的高血壓腦出血患者術前輸血的意義. 中國實用神經疾病雜志, 2017, 20(8): 118-119.
46. Spiegelstein D, Holmes SD, Pritchard G, et al. Preoperative hematocrit as a predictor of perioperative morbidities following nonemergent coronary artery bypass surgery. J Card Surg, 2015, 30(1): 20-26.
47. Yanagawa B, Rocha RV, Mazine A, et al. Hemoglobin optimization for coronary bypass: A 10-year Canadian multicenter experience. Ann Thorac Surg, 2019, 107(3): 711-717.
48. Sá MP, Soares EF, Santos CA, et al. Predictors of transfusion of packed red blood cells in coronary artery bypass grafting surgery. Rev Bras Cir Cardiovasc, 2011, 26(4): 552-558.
49. 周玉姣, 于坤. 體外循環紅細胞損傷的原因、表現及危害. 中國體外循環雜志, 2015, 13(1): 61-64.

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Risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting: A systematic review and meta-analysis

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