A pilot randomized trial comparing symptomatic vs. hemoglobin‐level‐ driven red blood cell transfusions following hip fracture

Carson, Jeffrey L.; Terrin, Michael L.; Barton, Franca B.; Aaron, Roy K.; Greenburg, A. Gerson; Heck, David A.; Magaziner, Jay; Merlino, F; Bunce, G. E.; McClelland, Brian; Duff, Amy; Noveck, Helaine

doi:10.1046/j.1537-2995.1998.38698326331.x

Cited by 208 publications

(161 citation statements)

References 21 publications

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“…Carson et al [72] Grover et al [73] Foss et al [74] Carson et al [75] Parker [76] So-Osman et al [77] All these RCTs focused on major lower limb surgery -elective hip/knee arthroplasty or hip fracture repair. There was heterogeneity between the studies with regard to the transfusion triggers used.…”

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confidence: 99%

Evidence and triggers for the transfusion of blood and blood products

2014

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SummaryAllogeneic red cell transfusion is a commonly used treatment to improve the oxygen carrying capacity of blood during the peri-operative period. Increasing arterial oxygen content by increasing haemoglobin does not necessarily increase tissue oxygen delivery or uptake. Although the evidence-base for red cell transfusion practice is incomplete, randomised studies across a range of clinical settings, including surgery, consistently support the restrictive use of red cells, with no evidence of benefit for maintaining patients at higher haemoglobin thresholds (liberal strategy). A recent meta-analysis of 7593 patients concluded that a restrictive transfusion strategy was associated with a reduced risk of healthcare-associated infections (pneumonia, mediastinitis, wound infection, sepsis) when compared with a liberal transfusion strategy. The degree to which the optimal haemoglobin concentration or transfusion trigger should be modified for patients with additional specific risk factors (e.g. ischaemic heart disease), remains less clear and requires further research. Although most clinical practice guidelines recommend restrictive use of red cells, and many blood transfusion services have seen marked falls in overall usage of red cells, the use of other blood components such as fresh frozen plasma, platelets, and cryoprecipitate has risen. In clinical practice, administration of fresh frozen plasma is usually guided by laboratory tests of coagulation, mainly prothrombin time, international normalised ratio and activated partial thromboplastin time, but the predictive value of these tests to predict bleeding is poor.

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confidence: 99%

Evidence and triggers for the transfusion of blood and blood products

2014

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“…Carson et al found that the mortality risk increases in patients with Hgb levels lower than 11 g/dL [4]. However, in two smaller studies, there was no significant relationship between levels of Hgb and mortality [29,30]. This finding in these two studies may be a result of a lack of statistical power: both groups had an increased risk because they had some level of anemia.…”

Section: Discussionmentioning

confidence: 93%

Preoperative anemia associated in-hospital mortality and morbidity in isolated coronary artery bypass graft surgery

et al. 2010

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AbstractAnemia is an indisputable finding in patients scheduled for coronary artery bypass graft (CABG) that can occur any time preoperatively. In presence of severe coronary artery disease, anemia can dramatically affect surgical outcomes. Therefore, we conducted this study to determine the effect of low preoperative hemoglobin (Hgb) on postoperative outcome in patients who underwent coronary artery bypass graft (CABG). In all, 4432 patients who had undergone isolated CABG at Tehran Heart Center over the 2-year period from March 2006 to February 2008 were studied. All medical records of the aforementioned patients were derived from our hospital surgery data bank. After adjustment for confounders, the association of different preoperative levels of Hgb with risk of cardiac, pulmonary, infectious, and ischemic complications, and also with prolonged ventilation and resource utilization, were assessed in a multivariable model. After adjustment for confounders that may affect mortality and morbidities, we found that cardiac, infectious, ischemic, and pulmonary complications, as well as postoperative mortality, were significantly higher in anemic patients compared to those with normal Hgb levels. In addition, total ventilation time, total intensive care unit hour stay (ICU), hospital length of stay (HLOS), and postsurgery length of stay (PLOS) were significantly longer in anemic patients. We concluded that isolated CABG patients with preoperative anemia have significantly higher mortality and morbidity, and use more health care resources. Preoperative anemia is an independent variable for increased resource utilization, morbidity, and mortality.

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“…Num estudo prospectivo 17 , comparando dois regimes de transfusão (restritivo -concentração de hemoglobina de 7 a 9 g/dL versus liberal -concentração de hemoglobina de 10 a 12 g/dL) em 838 pacientes de UTI, a mortalidade no 30º dia foi similar em ambos os grupos, mas a mortalidade no pós-operatório imediato foi mais alta no grupo liberal. Em estudo piloto comparando duas diferentes estratégias de transfusão em pacientes ortopédicos 18 , os autores demonstraram que para observar alguma diferença entre as duas estratégias seria necessário um total de 12.000 pacientes. Num estudo aleatoriamente encoberto com duas estratégias de transfusão (restritivo: concentração de hemoglobina de 7 g/dL ou liberal: hemoglobina concentração de 10 g/dL), foi demonstrado que o regime restritivo foi tão seguro como o liberal nos pacientes politraumatizados internados em UTI 19 .…”

Section: Discussionunclassified