Restrictive versus liberal blood transfusion in cardiac surgery


eMediNexus    05 January 2018

The Transfusion Requirements in Cardiac Surgery III (TRICS)-III trial published in The New England Journal of Medicine involving cardiac surgery patients from 19 countries showed that there are no benefits of liberal transfusion of blood over restrictive use. The primary composite outcome of hospital mortality, stroke, new renal failure requiring dialysis or new focal neurological deficit was reported in 11.4% of patients treated with the restrictive strategy vs. 12.5% in those treated with the liberal strategy. Mortality rates were almost similar between the 2 groups (restrictive vs. liberal: 3% vs 3.6%). No significant differences were observed in the secondary outcomes which included duration of hospital stay and mechanical ventilation; individual perioperative adverse events including myocardial infarction, stroke, delirium, infection, acute kidney injury, gut infarction, prolonged low cardiac output state, and platelets and plasma transfusion. It was noteworthy that in the subgroup analysis, patients aged ³ 75 years had better outcomes with the restrictive strategy.

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