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A liberal strategy of red blood cell transfusion reduces cardiovascular complications in older patients undergoing cardiac surgery
Critical Care volume 18, Article number: P107 (2014)
Owing to their high risk in cardiac surgery, it is essential to define which transfusion strategy results in a lower rate of cardiovascular complications in older patients . The aim of this study was to compare clinical outcomes after the implementation of either a restrictive or a liberal transfusion strategy in patients aged 60 years and above.
This study was a substudy of the Transfusion Requirements After Cardiac Surgery study. In this subgroup analysis we included all patients aged 60 years and above randomized to a restrictive or a liberal strategy of RBC transfusion. A composite endpoint for cardiovascular complications was used and defined as a combination of 30-day allcause mortality and severe cardiovascular morbidity.
The primary composite endpoint - all-cause 30-day mortality, cardiogenic shock, or myocardial infarction - occurred in 9.6% of patients in the liberal strategy group and in 18.4% in the restrictive strategy group (P = 0.041). The incidence of cardiogenic shock was 5.2% in the liberal group and 12.8% in the restrictive group (P = 0.031) and of myocardial infarction was 2.2% in the liberal group and 5.6% in the restrictive group (P = 0.203). There was no significant difference between transfusion strategies in 30-day mortality rates (4.4% vs. 8%, respectively; P = 0.23).
In this prospective, randomized clinical trial, older patients submitted to a restrictive strategy of RBC transfusion had a rate of cardiovascular complications in 30 days after cardiac surgery twice as high than a liberal strategy. In this group of patients, probably untreated anemia would be more harmful than in a younger or healthier population undergoing cardiac surgery.
Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, et al.: Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. 2010, 304: 1559-1567.
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Nakamura, R., Vincent, J., Fukushima, J. et al. A liberal strategy of red blood cell transfusion reduces cardiovascular complications in older patients undergoing cardiac surgery. Crit Care 18, P107 (2014). https://doi.org/10.1186/cc13297
- Cardiogenic Shock
- Cardiovascular Complication
- Composite Endpoint
- Strategy Group
- Primary Composite Endpoint