Evaluation of a novel Cardiac Peri-Operative Transfusion Trigger Scoring system in patients with coronary artery disease

Abstract

Background A simple and accurate scoring system to guide perioperative blood transfusion in patients with coronary artery disease (CAD) undergoing cardiac surgery is lacking. The trigger point for blood transfusions for these patients may be different from existing transfusion guidelines. This study aimed to evaluate the safety and efficacy of a new scoring strategy for use in guiding transfusion decisions in patients with CAD. Methods A multicenter randomized controlled trial was conducted at three third-level grade-A hospitals from January 2015 to May 2018. Data of 254 patients in a Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) group and 246 patients in a group receiving conventional evaluation of the need for transfusion (conventional group) were analysed. The requirements for transfusion and the per capita consumption of red blood cells (RBCs) were compared between groups. Results Baseline characteristics of the two groups were comparable. Logistic regression analyses revealed no significant differences between the two groups in primary outcomes (1-year mortality and perioperative ischemic cardiac events), secondary outcomes (shock, infections, and renal impairment), ICU admission, and ICU stay duration. However, patients in the cPOTTS group had significantly shorter hospital stays, lower hospital costs, lower utilization rate and lower per capita consumption of transfused RBCs than controls. Stratified analyses revealed no significant differences between groups in associations between baseline characteristics and perioperative ischemic cardiac events, except for hemofiltration or dialysis and NYHA class in I. Conclusions This novel scoring system offered a practical and straightforward guideline of perioperative blood transfusion in patients with CAD. Trial registration chiCTR1800016561(2017/7/19).

A Systematic Review and Meta-analysis of Randomized Controlled Trials Comparing Intraoperative Red Blood Cell Transfusion Strategies

“…Two studies utilized a perioperative transfusion trigger score to guide perioperative blood transfusion. 42 , 46 This score assessed factors such as markers of cardiac ischemia and vasopressor requirement before each transfusion to allow for dynamic changes in the hemoglobin transfusion trigger point. One study compared this score against usual care, 42 whereas the other study was a 3-armed study with a restrictive and liberal hemoglobin trigger as the other 2 arms.…”

“… 42 , 46 This score assessed factors such as markers of cardiac ischemia and vasopressor requirement before each transfusion to allow for dynamic changes in the hemoglobin transfusion trigger point. One study compared this score against usual care, 42 whereas the other study was a 3-armed study with a restrictive and liberal hemoglobin trigger as the other 2 arms. 46 For analysis purposes, outcome data for the perioperative transfusion trigger score group and the restrictive transfusion trigger group were combined and compared against the liberal transfusion trigger group.…”

“…Five studies had under 100 patients, 3,[35][36][37][38] and 1 trial accounted for 56% of patients. 39 Studies were conducted in variable surgical populations: cardiac surgery (n ¼ 6, 6709 patients, 78%), 3,37,[39][40][41][42] orthopedic surgery (n ¼ 4, 1007 patients, 12%), 35,[43][44][45] vascular surgery (n ¼ 2, 157 patients, 2%), 36,38 oncologic surgery (n ¼ 1, 423 patients, 5%), 46 and burn surgery (n ¼ 1, 345 patients, 4%). 47 All trials had a traditional 2-arm parallel design except for 1.…”

“…Risk of bias assessment for included trials is presented in Supplemental Digital Content 3 and 4, http://links.lww.com/SLA/ D136. Overall, 2 studies 3,35 were considered to be at high risk of bias, 7 studies 37,40,[42][43][44][45][46] had some concerns for bias, and 5 studies 36,38,39,41,47 were considered to be at low risk for bias. Of note, risk of bias assessment for 2 trials 42,46 was limited due to insufficient information provided in the manuscript for aspects such as randomization, allocation concealment, protocol adherence or suspension, and blinding.…”

“…Overall, 2 studies 3,35 were considered to be at high risk of bias, 7 studies 37,40,[42][43][44][45][46] had some concerns for bias, and 5 studies 36,38,39,41,47 were considered to be at low risk for bias. Of note, risk of bias assessment for 2 trials 42,46 was limited due to insufficient information provided in the manuscript for aspects such as randomization, allocation concealment, protocol adherence or suspension, and blinding. Both of these papers were considered to have concerns for potential bias across multiple domains.…”