Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study

Laine, Antti; Niemi, Tomi; Schramko, Alexey

doi:10.1053/j.jvca.2017.08.039

Cited by 23 publications

(17 citation statements)

References 26 publications

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“…We identified an additional 220 citations in the literature since our prior systematic review (Figure 1). Six additional studies and two conference proceedings fulfilled inclusion criteria 11,12,[21][22][23][24][25][26][27][28][29][30][31] for a total of 13 studies that were included-eight focused on adults and five included paediatric patients.…”

Section: Search Resultsmentioning

confidence: 99%

“…Two studies in adults were above 1000 patients. 11,12 The entire perioperative period was considered for haemoglobin thresholds in five trials focusing on adult cardiac patients, 12,21,24,26,31 whereas the remainder compared post-operative haemoglobin thresholds. Only one paediatric trial compared perioperative haemoglobin thresholds.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis

Shehata

Mistry

Costa

et al. 2018

European Heart Journal

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Section: Search Resultsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis

Shehata

Mistry

Costa

et al. 2018

European Heart Journal

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“…We identified seven relevant RCTs [48][49][50][51][52][53][54]. Implementation of a restrictive strategy likely has little to no difference on short-term mortality (28-30 days) (ARD − 0.1%, 95% CI − 0.9 to 1.0; RR 0.97, 95% CI 0.72 to 1.32, moderate certainty) and possibly little to no difference in longterm mortality (90 days to 6 months) (ARD 0.3%, 95% CI − 0.7 to 1.4; RR 1.05, 95% CI 0.86 to 1.28, low certainty).…”

Section: Evidence Summarymentioning

confidence: 99%

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

et al. 2020

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Objective: To develop evidence-based clinical practice recommendations regarding transfusion practices in nonbleeding, critically ill adults. Design: A task force involving 13 international experts and three methodologists used the GRADE approach for guideline development. Methods: The task force identified four main topics: red blood cell transfusion thresholds, red blood cell transfusion avoidance strategies, platelet transfusion, and plasma transfusion. The panel developed structured guideline questions using population, intervention, comparison, and outcomes (PICO) format. Results: The task force generated 16 clinical practice recommendations (3 strong recommendations, 13 conditional recommendations), and identified five PICOs with insufficient evidence to make any recommendation. Conclusions: This clinical practice guideline provides evidence-based recommendations and identifies areas where further research is needed regarding transfusion practices and transfusion avoidance in non-bleeding, critically ill adults.

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“…Specific transfusion timing was reported in 13 RCTs: 3 transfused intra-and post-operatively [35,40,44]; 6 transfused post-operatively [31,33,36,37,45,46] and 4 transfused peri-operatively [23,27,34,43]. For the remaining RCTs, 12 transfused during the hospital/ICU stay [21,22,25,28,29,32,39,41,42,[47][48][49] and the transfusion timing was not reported by the others [24,26,30,38,50].…”

Section: Included Rctsmentioning

confidence: 99%

Impact of restrictive red blood cell transfusion strategy on thrombosis‐related events: A meta‐analysis and systematic review

et al. 2022

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Background and Objectives: There is an ongoing controversy regarding the risks of restrictive and liberal red blood cell (RBC) transfusion strategies. This meta-analysis assessed whether transfusion at a lower threshold was superior to transfusion at a higher threshold, with regard to thrombosis-related events, that is, whether these outcomes can benefit from a restrictive transfusion strategy is debated. Materials and Methods:We searched PubMed, Cochrane Central Register of Controlled Trials and Scopus from inception up to 31 July 2021. We included randomized controlled trials (RCTs) in any clinical setting that evaluated the effects of restrictive versus liberal RBC transfusion in adults. We used random-effects models to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) based on pooled data.Results: Thirty RCTs involving 17,334 participants were included. The pooled RR for thromboembolic events was 0.65 (95% CI 0.44-0.94; p = 0.020; I 2 = 0.0%, very low-quality evidence), favouring the restrictive strategy. There were no significant differences in cerebrovascular accidents (RR = 0.83; 95% CI 0.64-1.09; p = 0.180; I 2 = 0.0%, very low-quality evidence) or myocardial infarction (RR = 1.05; 95% CI 0.87-1.26; p = 0.620; I 2 = 0.0%, low-quality evidence). Subgroup analyses showed that a restrictive (relative to liberal) strategy reduced (1) thromboembolic events in RCTs conducted in North America and (2) myocardial infarctions in the subgroup of RCTs where the restrictive transfusion threshold was 7 g/dl but not in the 8 g/dl subgroup (with a liberal transfusion threshold of 10 g/dl in both subgroups).Conclusions: A restrictive (relative to liberal) transfusion strategy may be effective in reducing venous thrombosis but not arterial thrombosis.

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Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study

Abstract: Hb threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable to 100 g/L in terms of bleeding and possibly short-term complications.

Cited by 23 publications

References 26 publications

Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis

Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: a meta-analysis

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Impact of restrictive red blood cell transfusion strategy on thrombosis‐related events: A meta‐analysis and systematic review

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