Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery

Mazer, C. David; Whitlock, Richard; Fergusson, Dean; Belley‐Côté, Emilie P.; Connolly, Katherine; Khanykin, Boris; Gregory, Alexander J.; Médicis, Étienne de; Carrier, François Martin; McGuinness, Shay; Young, Paul; Byrne, Kelly; Villar, Juan Carlos; Royse, Alistair; Grocott, Hilary P.; Seeberger, Manfred; Mehta, Chitra; Lellouche, François; Hare, Gregory M. T.; Painter, Thomas; Fremes, Stephen E.; Syed, Summer; Bagshaw, Sean M.; Hwang, Nian Chih; Royse, Colin; Hall, Judith Elizabeth; Dai, David; Mistry, Nikhil; Thorpe, Kevin E.; Verma, Subodh; Jüni, Peter; Shehata, Nadine

doi:10.1056/nejmoa1808561

Cited by 202 publications

(144 citation statements)

References 33 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…(AUC = 0.73; 95% CI, 0.66 to 0.78; P \ 0.001). AUC = area under the curve; CI = confidence interval The fact that more restrictive transfusion methods and lower levels of hemoglobin are becoming more acceptable during cardiac surgery 23 further emphasizes the importance of accurate point-of-care blood glucose measurements in anemic patients.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of blood glucose measurements using the NOVA StatStrip® glucometer during cardiac surgery: a prospective observational study

Nakadate

Sato

Roque

et al. 2019

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Accuracy of blood glucose measurements using the NOVA StatStrip® glucometer during cardiac surgery: a prospective observational study

Nakadate

Sato

Roque

et al. 2019

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…Mortality was 6.2% in the restrictive‐threshold group and 6.4% in the liberal‐threshold group (OR 0.95; 95% CI, 0.8, 1.2). There were no significant between‐group differences in the secondary outcomes after 28 days or 6 months . Intriguingly, subgroup analyses demonstrated that the restrictive strategy was associated with a lower risk of the composite outcome in patients 75 years or older, whereas the liberal strategy was associated with a lower risk of the composite outcome in patients younger than 75 years of age.…”

mentioning

confidence: 82%

“…There were no significant between-group differences in the secondary outcomes after 28 days or 6 months. 9 Intriguingly, subgroup analyses demonstrated that the restrictive strategy was associated with a lower risk of the composite outcome in patients 75 years or older, whereas the liberal strategy was associated with a lower risk of the composite outcome in patients younger than 75 years of age. The mechanism underlying a potential differential effect of age needs to be further explored as the findings were from subgroup analyses and were thus hypothesis-generating.…”

mentioning

confidence: 96%

Red cell transfusion in cardiac surgery: what is the right balance?

Shehata

Mazer

2019

Transfusion

Self Cite

View full text Add to dashboard Cite

Patients undergoing cardiac surgery are considered at increased risk of anemia‐induced tissue hypoxia and transfusion‐associated adverse events. Large recent randomized controlled trials addressing lowering the hemoglobin concentration for red cell transfusion (restrictive strategies) for these patients demonstrated slightly inconsistent results. Combining all randomized trials of restrictive strategies for red cell transfusion in cardiac surgery demonstrated that restrictive transfusion strategies are not inferior to liberal strategies.

show abstract

“…In the Transfusion Requirements in Cardiac Surgery (TRICS)-3 trial, a lower Hb threshold for RBC transfusion was favoured in patients at least 75 years of age. 13,17 In contrast, in the Transfusion Requirements in Critical Care (TRICC) trial, potential benefit with a lower Hb threshold was suggested among patients younger than 55 years of age. 4 In 2 other large trials, no heterogeneous effects of different Hb thresholds for RBC transfusion were observed in patients of different ages.…”

mentioning

confidence: 99%

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

Jonsson

Granholm

Rygård

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Background Use of a lower haemoglobin (Hb) threshold to guide red blood cell (RBC) transfusion is now generally recommended in critically ill patients, but uncertainty remains regarding the optimal Hb threshold for RBC transfusion in patients of different ages. Methods We conducted a post‐hoc analysis of 998 patients with septic shock and anaemia randomised to RBC transfusion at a Hb threshold of 7 g/dl [4.3 mmol/l] vs 9 g/dl [5.6 mmol/l] in the Transfusion Requirements in Septic Shock (TRISS) trial. We assessed if there were heterogeneous effects between the allocated Hb threshold and patient age categorised and on the continuous scale. The primary outcome was 1‐year mortality; the secondary outcome was 90‐day mortality. Both outcomes were analysed using logistic regression models and in sensitivity analyses with additional adjusting for site of enrolment, presence of haematological malignancy and the Sequential Organ Failure Assessment (SOFA) score. The secondary analyses were Kaplan‐Meier curves with corresponding log‐rank tests. Results We found no heterogeneity between patient age and the allocated Hb thresholds for RBC transfusion for 1‐year mortality or 90‐day mortality in the primary analyses. The sensitivity analyses suggested heterogeneity between age groups regarding 90‐day mortality, however, this was not consistent for 1‐year mortality or when assessing age on the continuous scale. Conclusion In this post‐hoc study of ICU patients with septic shock, we found no reliable heterogeneous effects of transfusion at a Hb threshold of 7 vs 9 g/dl according to patient age on mortality. However, due to low power, this study should only be considered as hypothesis generating.

show abstract

Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery

Cited by 202 publications

References 33 publications

Accuracy of blood glucose measurements using the NOVA StatStrip® glucometer during cardiac surgery: a prospective observational study

Accuracy of blood glucose measurements using the NOVA StatStrip® glucometer during cardiac surgery: a prospective observational study

Red cell transfusion in cardiac surgery: what is the right balance?

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

Contact Info

Product

Resources

About