A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery

Abstract

Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy may result in an increased rate of cardiogenic shock in elderly patients undergoing cardiac surgery compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients.

Blood Transfusions Correct Anemia and Improve Tissue Oxygenation in Surgical and Critically ill Patients

“…Similar findings were also reported in a large Korean study on septic patients by Park et al (13) who showed better outcome in septic patients who had received blood transfusions. In parallel similar results have been found in other groups of surgical patients including cardiac surgery and cancer patients showing the benefit of transfusing blood (14,15). All these findings underscore the general conclusion that avoiding anemia by targeting a conservative (eg 9 g/dL) transfusion trigger is with the current blood received from modern blood banks, a safe procedure of benefit especially for the elderly patient at risk.…”

Heterogenous treatment effects of transfusion thresholds by patient age: Post‐hoc analysis of the TRISS trial

“…A concern regarding a lower Hb threshold for RBC transfusion in elderly patients has been raised in a recent post‐hoc analysis of the Transfusion Requirements after Cardiac Surgery (TRACS) trial and in a systematic review . Both, however, preceded the Transfusion Requirements in Cardiac Surgery (TRICS‐3) trial, in which a lower Hb threshold was associated with decreased risk of occurrence of a composite outcome of death at day 28, non‐fatal myocardial infarction, stroke and new‐onset renal failure in patients ≥75 years ( P = .004 for interaction, unadjusted OR: 0.70, 95% CI: 0.54‐0.89) .…”

Comparison of liberal and restrictive blood transfusion: current insights into clinical outcomes

“…In the patients <60 years no such difference was found. 46 In infants and children with elective partial or total cavopulmonary connection, Cholette et al 17 found no benefit from a liberal transfusion strategy with an Hb threshold of 13 g/dL compared to a restrictive of 9 g/ dL within 48 hours after surgery. …”

“…This difference was not present in younger patients. 46 Only six of the 30 RCTs used age inclusion criteria >18 years: ≥50 years in hip fracture patients, 31 ≥55 years in critically ill patients and elective surgery, 12,29 ≥60 years, 4 and ≥65 years in hip fracture patients, 16,56 and ≥70 years in elective hipand knee replacement patients (a high-risk subgroup). 30 For the FOCUS study, Carson et al 31 selected high-risk patients defined by CVD.…”