%0 Journal Article
%T Postoperative Transfusion Guidelines in Aneurysmal Cerebral Subarachnoid Hemorrhage: A Systematic Review and Critical Summary of Currently Available Evidence.
%A Mofor P
%A Oduguwa E
%A Tao J
%A Barrie U
%A Kenfack YJ
%A Montgomery E
%A Edukugho D
%A Rail B
%A Hicks WH
%A Pernik MN
%A Adeyemo E
%A Caruso J
%A El Ahmadieh TY
%A Bagley CA
%A De Oliveira Sillero R
%A Aoun SG
%J World Neurosurg
%V 0
%N 0
%D Dec 2021 7
%M 34890850
%F 2.21
%R 10.1016/j.wneu.2021.12.007
%X <B>OBJECTIVE: </B>Surgical management of aneurysmal subarachnoid hemorrhage (SAH) often involves red blood cell (RBC) transfusion, which increases the risk of post-operative complications. Current RBC transfusion guidelines report on chronically critically-ill patients and may not apply to SAH patients. Our study aims to synthesize available evidence to recommend RBC transfusion thresholds among adult SAH patients undergoing surgery.<BR><B>METHODS: </B>A systematic review was conducted using PubMed, Google Scholar, and Web of Science electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to critically assess primary articles discussing RBC transfusion thresholds and describe complications secondary to RBC transfusion in adult SAH patients in the perioperative period.<BR><B>RESULTS: </B>16 articles meeting our search strategy were reviewed. SAH patients who received blood transfusion were older, female, world federation of neurosurgical societies grade IV-V, modified fisher grade 3-4 scores and presented with more comorbidities such as hypertension, diabetes, cardiovascular and pulmonary diseases. In addition, transfusion was associated with multiple post-operative complications, including higher rates of vasospasms, surgical site infections, cardiovascular and respiratory complications, increased postoperative length of stay and 30-day mortality. Analysis of transfused patients showed that a higher Hb (>10) goal after SAH was safe and patients may benefit from a higher whole hospital stay Hb nadir, as evidenced by a reduction in risk of cerebral vasospasm and improvement in clinical outcomes (Level B Class II).<BR><B>CONCLUSIONS: </B>Among SAH patients, the benefits of reducing cerebral ischemia and anemia are shown to outweigh the risks of transfusion-related complications.