Cardiac Surgery: Restrictive vs Liberal Threshold for Red-Cell Transfusion
Mortality was 3% and 3.6% in the restrictive- and liberal-threshold groups, respectively.
HealthDay News — A restrictive threshold for red-cell transfusion is noninferior to a liberal threshold for patients undergoing cardiac surgery with moderate to high risk of death, according to a study published in the New England Journal of Medicine to coincide with the American Heart Association's Scientific Sessions, held November 11 to 15 in Anaheim, California.
C. David Mazer, MD, from the Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital in Canada, and colleagues conducted a multicenter noninferiority trial involving 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation score of 6 or higher. Participants were randomized to a restrictive red-cell transfusion threshold or a liberal red-cell transfusion threshold. The primary outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by either day 28 or hospital discharge, whichever was first.
The researchers found that the primary outcome occurred in 11.4% and 12.5% of patients in the restrictive-threshold and liberal-threshold groups, respectively (absolute risk difference, −1.11 percentage points; 95% CI, −2.93 to 0.72; odds ratio, 0.9; 95% CI, 0.76-1.07; P <.001 for noninferiority). Mortality was 3% and 3.6% in the restrictive- and liberal-threshold groups, respectively (odds ratio, 0.85; 95% CI, 0.62-1.16).
"A restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused," the authors wrote.
Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or liberal red-cell transfusion for cardiac surgery [published online November 12, 2017]. N Engl J Med. doi:10.1056/NEJMoa1711818