A liberal strategy of red blood cell transfusion reduces cardiovascular complications in older patients undergoing cardiac surgery

  • Nakamura R
  • Vincent J
  • Fukushima J
  • et al.
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Abstract

Introduction Owing to their high risk in cardiac surgery, it is essential to define which transfusion strategy results in a lower rate of cardiovascular complications in older patients [1]. The aim of this study was to compare clinical outcomes after the implementation of either a restrictive or a liberal transfusion strategy in patients aged 60 years and above. Methods This study was a substudy of the Transfusion Requirements After Cardiac Surgery study. In this subgroup analysis we included all patients aged 60 years and above randomized to a restrictive or a liberal strategy of RBC transfusion. A composite endpoint for cardiovascular complications was used and defined as a combination of 30-day allcause mortality and severe cardiovascular morbidity. Results The primary composite endpoint - all-cause 30-day mortality, cardiogenic shock, or myocardial infarction - occurred in 9.6% of patients in the liberal strategy group and in 18.4% in the restrictive strategy group (P = 0.041). The incidence of cardiogenic shock was 5.2% in the liberal group and 12.8% in the restrictive group (P = 0.031) and of myocardial infarction was 2.2% in the liberal group and 5.6% in the restrictive group (P = 0.203). There was no significant difference between transfusion strategies in 30-day mortality rates (4.4% vs. 8%, respectively; P = 0.23). Conclusion In this prospective, randomized clinical trial, older patients submitted to a restrictive strategy of RBC transfusion had a rate of cardiovascular complications in 30 days after cardiac surgery twice as high than a liberal strategy. In this group of patients, probably untreated anemia would be more harmful than in a younger or healthier population undergoing cardiac surgery.

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Nakamura, R., Vincent, J., Fukushima, J., Almeida, J., Bergamin, F., Park, C., … Hajjar, L. (2014). A liberal strategy of red blood cell transfusion reduces cardiovascular complications in older patients undergoing cardiac surgery. Critical Care, 18(S1). https://doi.org/10.1186/cc13297

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