Anemia is Common Following Aneurysmal Subarachnoid Hemorrhage:  SAHaRA - a Canadian Multi-Centre Retrospective Cohort Study
CCCF ePoster library. English S. Oct 27, 2015; 117354; P64 Disclosure(s): This work completed with grants from the Departments of Medicine and Critical Care, The Ottawa Hospital.
Shane English
Shane English
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Aneurysmal subarachnoid hemorrhage (aSAH) is a common neurologic condition requiring intensive care unit (ICU) admission1. Mortality estimates are high (20 – 67%)2 and morbidity can be devastating; less than one third of survivors achieve a full functional recovery3. The epidemiology of anemia and transfusion practices for patients in Canada who have suffered an aSAH are unknown but are essential to understand before designing transfusion related clinical trials in this patient population.

To describe: the disease burden of an aSAH population in Canadian hospitals; the prevalence and incidence of moderate anemia (hemoglobin <100 g/L) during those admissions; and the frequency of RBC transfusion.

Design/Setting: This is a multi-centre retrospective cohort study conducted at four Canadian academic tertiary care centres from January 1, 2012 to December 31, 2013. Study Population: All adult patients admitted to the study hospitals between January 1, 2012 and December 31, 2013 with aSAH secondary to a ruptured aneurysm were included. The diagnosis was confirmed by presence of blood in the subarachnoid space (on any of imaging, lumbar puncture or post-mortem examination) as caused by ruptured cerebral aneurysm (as demonstrated on any of angiography, neuro-imaging or post-mortem examination). Patient Identification: aSAH patients were identified from two patient sources (hospital administrative discharge records and existing local SAH databases). Trained data abstractors confirmed the diagnosis using the inclusion criteria by primary chart review. Data Collection: Chart reviews were conducted by trained abstractors to collect demographic data, aSAH characteristics, administration of RBC transfusion, daily hemoglobin concentrations and nadir hemoglobin, other major aSAH co-interventions, and outcomes using a pre-tested case report form and a standardized operations manual. Analysis: Descriptive statistics were used.

From 886 screened patients, a total of 527 (59.5%) with aSAH met study eligibility criteria. Mean (±SD) age was 57±13 years and 357 (67.7%) were female. The most common prior medical history was presence of hypertension (44.2%) and active tobacco smokers (35.1%). Aneurysms occurred in the anterior circulation in 62.0% of cases, and mean aneurysm size was 6.9±4.3 mm. Median presenting Glasgow Coma Scale score and Fisher Grade was 14 (IQR 11-15) and 4 (IQR 3-4) respectively. Of those aneurysms that were secured (90.1%), 52.2% underwent endovascular coiling and 39.7% underwent surgical clipping. Mean admission and nadir hemoglobin were 130.3±16.8 g/L and 98.0±19.5 g/L, respectively. Nadir hemoglobin occurred on median post-admission day (PAD) 4 (IQR 2-11). Within the first 21 days of admission, moderate anemia occurred in 273 (51.8%) of patients by median PAD 2 (1-4). RBC transfusion occurred in 101 (19.2%) of patients. In-hospital mortality was 17.7%; Of the survivors, 35.3% were discharged from hospital with moderate to severe disability.

In our retrospective cohort study of all aSAH admissions to 4 Canadian academic tertiary care centres we observed that moderate anemia is common (51% of all cases), and occurs early in admission. Less than 20% of aSAH patients received a RBC transfusion. Acute aSAH remains a clinical problem that is associated with significant mortality, and morbidity for survivors.

1. Reed SD, Blough DK, Meyer K, Jarvik JG. Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals. Neurology 2001;57(2):305–14.
2. Nieuwkamp DJ, Setz LE, Algra A, Linn FHH, de Rooij NK, Rinkel GJE. Changes in case fatality of aneurysmal subarachnoid haemorrhage over time, according to age, sex, and region: a meta-analysis. Lancet Neurol 2009;8(7):635–42.
3. Le Roux PD. Anemia and transfusion after subarachnoid hemorrhage. Neurocrit Care 2011;15(2):342–53.
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