2017
DOI: 10.1016/j.athoracsur.2017.05.048
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Abstract: Negative exposures differed between treatment groups, with lower hematocrit in the 24% trigger group and more red blood cells used in the 28% group, but adverse outcomes did not differ. Because red blood cell use was less with a 24% trigger without adverse effects, our randomized trial results support aggressive blood conservation efforts in cardiac surgery.

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Cited by 58 publications
(57 citation statements)
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“…8 It is also important to highlight that definitions for what constitutes restrictive and liberal hemoglobin thresholds differ among studies. 3,5,6,8 These trials provide us with a better understanding of the appropriate use of an expensive resource for which cardiac surgery ranks among the highest of consumers. Transfusing when unnecessary is a form of health care waste, resulting in potential harm along with the increased health care costs associated with transfusion.…”
Section: Central Messagementioning
confidence: 99%
See 1 more Smart Citation
“…8 It is also important to highlight that definitions for what constitutes restrictive and liberal hemoglobin thresholds differ among studies. 3,5,6,8 These trials provide us with a better understanding of the appropriate use of an expensive resource for which cardiac surgery ranks among the highest of consumers. Transfusing when unnecessary is a form of health care waste, resulting in potential harm along with the increased health care costs associated with transfusion.…”
Section: Central Messagementioning
confidence: 99%
“…Randomized, controlled trials on transfusion uniformly demonstrate that fewer patients are transfused when randomly allocated to a restrictive transfusion strategy and that overall a restrictive strategy results in a reduction in blood use of approximately a third. 3,5,6,8 Incremental costs associated with restrictive and liberal transfusion strategies were examined by Stokes and colleagues 14 in an analysis of the findings from TITRe2 study. A restrictive transfusion strategy was considered more effective and less costly than a liberal approach.…”
Section: Central Messagementioning
confidence: 99%
“…The Figure is a forest plot of all trials of red cell transfusion thresholds in cardiac surgical patients for the outcome of in-hospital or 30-day mortality. [4][5][6][7][8][9][10] This shows that in over 8,000 adult cardiac surgical patients, restrictive transfusion is as safe as liberal transfusion (OR, 0.98; 95% CI, 0.77 to 1.25). The TRICS III trial shifts the effect estimate to the midline, which contrasts the findings of our recent meta-analysis that suggested that there may be a trend towards benefit with liberal transfusion.…”
Section: Does Trics III Change Practice?mentioning
confidence: 99%
“…La figure est un graphique en forêt (« forest plot ») de tous les essais sur les seuils de transfusion de globules rouges chez des patients chirurgicaux cardiaques pour le critère d'évaluation de mortalité à l'hôpital ou à 30 jours. [4][5][6][7][8][9][10] Elle montre que chez plus de 8 000 patients chirurgicaux cardiaques adultes, le seuil restrictif est aussi sécuritaire que le seuil généreux de transfusions (OR, 0,98; IC à 95 %, 0,77 à 1,25). L'étude TRICS III pousse l'estimation de l'effet vers la ligne médiane, ce qui contraste avec les constatations de notre récente méta-analyse qui suggérait une tendance vers un avantage pour un seuil libéral de transfusions.…”
Section: Where To Next?unclassified
“…Another recent RCT (transfusion trigger in cardiac surgery) also supported the restrictive strategy. 25 Thus, currently the picture appears to be much clearer than before and the restrictive regimen has developed strongholds in the transfusion practice, which is reflected in the latest European guidelines. 26 Although the guidelines recommend transfusion (class IIb) at a hematocrit level of 21% to 24% during cardiopulmonary bypass, they also clarify that transfusion should be performed based on the clinical condition of the patient rather than a fixed Hb threshold.…”
mentioning
confidence: 99%