Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery

Abstract

In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .).

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

“…Although lower hemoglobin (8.8 versus 13.1 g/dL) preoperatively and on arrival to the intensive care unit has been associated with persistent AKI after cardiac surgery, transfusion of at least 2 U of packed red blood cells has also been associated with higher incidence of CVS‐AKI . In 2 recent RCTs in which patients were randomized to a liberal (Hg <9.5 g/dL) or restrictive (Hg <7.5 g/dL) transfusion policy intraoperatively and postoperatively, there was no difference in postoperative outcomes including AKI . In addition, studies have failed to demonstrate any benefit in the use of erythropoietin in the prevention of postoperative AKI .…”

Highlights from the 2017 American Heart Association Scientific Sessions in Anaheim, California

“…The unknown balance of risks of anemia-induced tissue hypoxia versus risks due to transfusions, led the investigators of the Transfusion Requirements in Cardiac Surgery (TRISC) III trial to evaluate these strategies in adult patients undergoing cardiac surgery with cardiopulmonary bypass [4]. Using a noninferiority design, patients with a EuroSCORE I of 6 or higher (higher scores indicating higher risk of death after cardiac surgery) were randomized 1:1 to a transfusion threshold of: (1) 7.5 g/dL intraoperatively and postoperatively, versus (2) 9.5 g/dL intraoperatively and in the ICU and then 8.5 g/dL in the non-ICU ward.…”

A multi‐center analysis of readmission after cardiac surgery: Experience of The Northern New England Cardiovascular Disease Study Group

“…On the basis of preoperative comorbidities alone, patients with preoperative creatinine more than or equal to 2, CHF, COPD and diabetes, as well as those undergoing valve surgery, may benefit from distinct postoperative and discharge care pathways that are reflective of their increased risk. The increased likelihood of readmission for patients transfused more than or equal to 3 units of packed red blood cells reinforces the importance of a restrictive transfusion strategy for cardiac surgical patients …”