Abstract 356: Outcomes of Blood Transfusions in Patients Undergoing Mechanical Thrombectomy for Acute Ischemic Stroke: A US Nationwide Analysis
Authors: Jain A. , Aifuwa E. , Spirollari E. , Bienenstock R. , Kar S. , Sacknovitz A. , Al‐Mufti F. 
Published: January 2025

Introduction/Purpose
Large vessel occlusion resulting in acute ischemic stroke (AIS) is a critical and prevalent condition, significantly contributing to the overall burden of stroke. Management of AIS focuses on swift restoration of blood flow to minimize ischemic time and improve outcomes. This is accomplished through a combination of intravenous thrombolysis and mechanical thrombectomy. Recent literature has suggested a role for blood transfusion in supporting cerebral perfusion in the setting of large vessel AIS. In this study, we utilized a nationally representative sample of inpatient data to explore patient characteristics, complications, and outcomes of blood transfusions in AIS patients undergoing mechanical thrombectomy.

Methods
A query of the 2016‐2019 National Inpatient Sample (NIS) was performed for patients admitted to hospitals with ICD‐10 diagnosis codes for AIS, further specified by patients undergoing mechanical thrombectomy. Demographic and clinical characteristics were analyzed for AIS patients who received blood transfusions during their inpatient admission, in comparison to AIS patients who did not receive blood transfusions. Severity of presentation, complications, and other sequelae were also assessed. A multivariate binary logistic regression was performed to evaluate the outcomes of complications, prolonged length of stay, discharge disposition, and inpatient mortality, while controlling for age, gender, NIS‐Subarachnoid Hemorrhage Severity scores, and Elixhauser Comorbidity Index. All statistical analyses were performed using Statistical Product and Service Solutions (SPSS, V. 28).

Results
A total of 47,835 AIS patients undergoing mechanical thrombectomy were identified. Patients who received blood transfusions had higher rates of sepsis (OR 3.295, 2.637‐4.118, p<0.001), deep vein thrombosis (OR 1.635, 1.279‐2.092, p<0.001), acute kidney injury (OR 2.519, 2.218‐2.862, p<0.001), tracheostomy (OR 5.13, 4.205‐6.259, p<0.001), herniation (OR 2.381, 2.028‐2.796, p<0.001), mechanical ventilation (OR 2.648, 2.326‐3.014, p<0.001), and cerebral edema (OR 1.538, 1.353‐1.748, p<0.001), compared to AIS patients who did not receive blood transfusions. In terms of clinical outcomes, AIS patients treated with mechanical thrombectomy who received blood transfusions were more likely to experience prolonged length of stay (OR 3.389, 2.989‐3.842, p<0.001), transfer to a skilled nursing facility (OR 1.163, 1.036‐1.306, p=0.01), and death (OR 1.563, 1.492‐1.638, p<0.001). Furthermore, rates of routine discharge (OR 0.342, 0.279‐0.418, p<0.001) were decreased in those receiving blood transfusions compared to those who did not receive blood transfusions.

Conclusions
In this nationally‐representative analysis of the outcomes and trends associated with blood transfusions in patients undergoing mechanical thrombectomy for AIS, we found that blood transfusions in this setting are associated with higher rates of complications, prolonged hospital stays, and increased inpatient mortality. Understanding the long‐term impact of blood transfusions in AIS patients undergoing mechanical thrombectomy is crucial in evaluating the necessity and timing of transfusions to balance the clinical benefits and risks effectively.