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Liberal or restrictive transfusion after cardiac surgery

Plumb, James O.M. and Grocott, Michael P.W. (2015) Liberal or restrictive transfusion after cardiac surgery New England Journal of Medicine, 373, (2), pp. 192-1933. (doi:10.1056/NEJMoa1403612). (PMID:25760354).

Record type: Article

Abstract

Background: whether a restrictive threshold for hemoglobin level in red-cell transfusions, as compared with a liberal threshold, reduces postoperative morbidity and health care costs after cardiac surgery is uncertain.

Methods: we conducted a multicenter, parallel-group trial in which patients older than 16 years of age who were undergoing nonemergency cardiac surgery were recruited from 17 centers in the United Kingdom. Patients with a postoperative hemoglobin level of less than 9 g per deciliter were randomly assigned to a restrictive transfusion threshold (hemoglobin level <7.5 g per deciliter) or a liberal transfusion threshold (hemoglobin level <9 g per deciliter). The primary outcome was a serious infection (sepsis or wound infection) or an ischemic event (permanent stroke [confirmation on brain imaging and deficit in motor, sensory, or coordination functions], myocardial infarction, infarction of the gut, or acute kidney injury) within 3 months after randomization. Health care costs, excluding the index surgery, were estimated from the day of surgery to 3 months after surgery.

Results: a total of 2007 patients underwent randomization; 4 participants withdrew, leaving 1000 in the restrictive-threshold group and 1003 in the liberal-threshold group. Transfusion rates after randomization were 53.4% and 92.2% in the two groups, respectively. The primary outcome occurred in 35.1% of the patients in the restrictive-threshold group and 33.0% of the patients in the liberal-threshold group (odds ratio, 1.11; 95% confidence interval [CI], 0.91 to 1.34; P=0.30); there was no indication of heterogeneity according to subgroup. There were more deaths in the restrictive-threshold group than in the liberal-threshold group (4.2% vs. 2.6%; hazard ratio, 1.64; 95% CI, 1.00 to 2.67; P=0.045). Serious postoperative complications, excluding primary-outcome events, occurred in 35.7% of participants in the restrictive-threshold group and 34.2% of participants in the liberal-threshold group. Total costs did not differ significantly between the groups.

Conclusions: a restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs

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More information

Published date: 9 July 2015
Organisations: Clinical & Experimental Sciences

Identifiers

Local EPrints ID: 384065
URI: http://eprints.soton.ac.uk/id/eprint/384065
PURE UUID: 61af1eac-a21d-4d33-88b0-684965106dc3

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Date deposited: 04 Dec 2015 11:57
Last modified: 17 Jul 2017 20:08

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Author: James O.M. Plumb

University divisions

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