Liberal or Restrictive Transfusion After Cardiac Surgery?
Journal Wrap | A restrictive transfusion threshold after cardiac surgery compared to a liberal threshold was not found to be superior in terms of morbidity or health care costs, according to results from a new study published in the New England Journal of Medicine.
Study investigators conducted a multicenter, parallel-group trial in which 2,003 patients undergoing nonemergency cardiac surgery who had a postoperative hemoglobin level of <9 g/dl were randomly assigned to a restrictive transfusion threshold (hemoglobin level <7.5 g/dl) or a liberal transfusion threshold (hemoglobin level <9 g/dl). The primary outcome was a serious infection (sepsis or wound infection) or an ischemic event (permanent stroke, myocardial infarction, infarction of the gut, or acute kidney injury) within 3 months after randomization. Healthcare costs, excluding the index surgery, were estimated from the day of surgery to 3 months after surgery.
Results found that transfusion rates after randomization were 53.4% in the restrictive group and 92.2% in the liberal group. There was no difference in the primary outcome between the two arms (35.1% of the patients in the restrictive-threshold group and 33.0% of the patients in the liberal-threshold group; odds ratio, 1.11; 95% confidence interval, 0.91-1.34; p = 0.30). In addition, there was no difference in total costs between the two groups.
Study results also indicated more deaths in the restrictive-threshold group than in the liberal-threshold group (4.2% vs. 2.6%; hazard ratio, 1.64; 95% confidence interval, 1.00-2.67; p = 0.045). Serious postoperative complications, excluding primary-outcome events, were slightly higher in the restrictive threshold group—35.7% of participants vs. 34.2% of participants in the liberal-threshold group.
According to Hitinder S. Gurm, MBBS, in an ACC Journal Scan, this study will likely cause centers, most of which currently favor a restrictive transfusion policy, to re-examine their policies.
Murphy G, Pike K, Rogers C, et al. N Engl J Med. 2015;372:997-1008.
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