Transfusion Requirements After Cardiac Surgery (TRACS) study: preliminary data of a randomized controlled clinical trial

Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

“…Recent studies found a prevalence of 24.7 to 54.2% of patients receiving RBCs after cardiac surgery (2)(3)6,8,(17)(18)(19)(20)(21)(22) .…”

“…Transfusion triggers vary from Hct<23% to Hct<30% (6,(17)(18)(19) . The first randomized clinical trial to compare a liberal with a restrictive RBC transfusion strategy in patients undergoing cardiac surgery suggested that transfusion targeting a Hct of 24% is as safe as targeting a Hct of 30%, with respect to a composite end point of 30-day mortality and inpatient clinical complications (6) . Therefore, triggers are expected to become increasingly restrictive worldwide.…”

“…In the short term, RBC transfusion ≥4 units is an independent predictor of one-year mortality (2) . The risk for cardiac morbidity, different types of infections, acute respiratory distress syndrome and acute renal injury requiring dialysis or hemofiltration is also increased after RBC transfusion (1,4,6) .…”

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…35 With the risk of transfusion-related morbidity and mortality in mind, three randomized trials in adults and children have demonstrated that lower Hb thresholds were well-tolerated in critically ill patients and cardiac surgical patients. 14,36 Furthermore, the physiological premise that acute hemodilution optimized blood rheology and favoured perfusion led to clinical approaches that further reduced red cell mass in a number of clinical settings. 4 The collective impact of these influences promoted a clinical attitude of tolerance for acute and chronic anemia.…”

“…35 En gardant à l'esprit le risque de morbidité et de mortalité liées aux transfusions, trois études randomisées réalisées chez des adultes et des enfants ont démontré que des seuils de Hb relativement bas étaient bien tolérés chez les patients gravement malades et chez les patients de chirurgie cardiaque. 14,36 De plus, le postulat physiologique selon lequel l'hémodilution aiguë optimise la rhéologie sanguine et favorise la perfusion a mené à l'élaboration de plusieurs approches cliniques afin de réduire encore plus la masse érythrocytaire dans plusieurs contextes cliniques. 4 L'impact cumulatif de ces influences a mené à une attitude clinique de tolérance de l'anémie aiguë et chronique.…”