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Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis*.
Crit Care Med. 2014 Dec; 42(12):2611-24.CC

Abstract

OBJECTIVE

Restrictive red cell transfusion is recommended to minimize risk associated with exposure to allogeneic blood. However, perioperative anemia is an independent risk factor for adverse outcomes after cardiovascular surgery. The purpose of this systematic review and meta-analysis is to determine whether perioperative restrictive transfusion thresholds are associated with inferior clinical outcomes in randomized trials of cardiovascular surgery patients.

DATA SOURCES

The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to October 2013; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings. No language restrictions were applied.

STUDY SELECTION

We included controlled trials in which adult patients undergoing cardiac or vascular surgery were randomized to different transfusion thresholds, described as a hemoglobin or hematocrit level below which RBCs were transfused.

DATA EXTRACTION

Two authors independently extracted data from included trials. We pooled risk ratios of dichotomous outcomes and mean differences of continuous outcomes across trials using random-effects models.

DATA SYNTHESIS

Seven studies (enrolling 1,262 participants) met inclusion criteria with restrictive and liberal transfusion thresholds most commonly differing by a hemoglobin of 1 g/dL or hematocrit of 6-7%, resulting in decreased transfusions by 0.71 units of RBCs (95% CI, 0.31-1.09, p = 0.0002) without an associated change in adverse events: mortality (risk ratio, 1.12; 95% CI, 0.65-1.95; p = 0.60), myocardial infarction (risk ratio, 0.94; 95% CI, 0.30-2.99; p = 0.92), stroke (risk ratio, 1.15; 95% CI, 0.57-2.32; p = 0.70), acute renal failure (risk ratio, 0.98; 95% CI, 0.64-1.49; p = 0.91), infections (risk ratio, 1.23; 95% CI, 0.85-1.78; p = 0.27), or length of stay. There was no between-trial heterogeneity for any pooled analysis. Including four pediatric trials (456 participants) and 10 trials utilizing only intraoperative acute normovolemic hemodilution (872 participants) did not substantially change the results except that unlike the transfusion threshold trials, the hemodilution trials did not reduce the proportion of patients transfused (interaction p = 0.01).

CONCLUSIONS

Further randomized controlled trials are necessary to determine the optimal transfusion strategy for patients undergoing cardiovascular surgery.

Authors+Show Affiliations

1Departments of Anesthesia and Critical Care, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 2Departments of Medicine and Laboratory Medicine and Pathobiology (Mount Sinai Hospital), Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 3Department of Anesthesia, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada. 4Departments of Critical Care and Medicine, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

25167086

Citation

Curley, Gerard F., et al. "Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery: a Systematic Review and Meta-analysis*." Critical Care Medicine, vol. 42, no. 12, 2014, pp. 2611-24.
Curley GF, Shehata N, Mazer CD, et al. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis*. Crit Care Med. 2014;42(12):2611-24.
Curley, G. F., Shehata, N., Mazer, C. D., Hare, G. M., & Friedrich, J. O. (2014). Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis*. Critical Care Medicine, 42(12), 2611-24. https://doi.org/10.1097/CCM.0000000000000548
Curley GF, et al. Transfusion Triggers for Guiding RBC Transfusion for Cardiovascular Surgery: a Systematic Review and Meta-analysis*. Crit Care Med. 2014;42(12):2611-24. PubMed PMID: 25167086.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis*. AU - Curley,Gerard F, AU - Shehata,Nadine, AU - Mazer,C David, AU - Hare,Gregory M T, AU - Friedrich,Jan O, PY - 2014/8/29/entrez PY - 2014/8/29/pubmed PY - 2015/1/24/medline SP - 2611 EP - 24 JF - Critical care medicine JO - Crit. Care Med. VL - 42 IS - 12 N2 - OBJECTIVE: Restrictive red cell transfusion is recommended to minimize risk associated with exposure to allogeneic blood. However, perioperative anemia is an independent risk factor for adverse outcomes after cardiovascular surgery. The purpose of this systematic review and meta-analysis is to determine whether perioperative restrictive transfusion thresholds are associated with inferior clinical outcomes in randomized trials of cardiovascular surgery patients. DATA SOURCES: The Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE from inception to October 2013; reference lists of published guidelines, reviews, and associated articles, as well as conference proceedings. No language restrictions were applied. STUDY SELECTION: We included controlled trials in which adult patients undergoing cardiac or vascular surgery were randomized to different transfusion thresholds, described as a hemoglobin or hematocrit level below which RBCs were transfused. DATA EXTRACTION: Two authors independently extracted data from included trials. We pooled risk ratios of dichotomous outcomes and mean differences of continuous outcomes across trials using random-effects models. DATA SYNTHESIS: Seven studies (enrolling 1,262 participants) met inclusion criteria with restrictive and liberal transfusion thresholds most commonly differing by a hemoglobin of 1 g/dL or hematocrit of 6-7%, resulting in decreased transfusions by 0.71 units of RBCs (95% CI, 0.31-1.09, p = 0.0002) without an associated change in adverse events: mortality (risk ratio, 1.12; 95% CI, 0.65-1.95; p = 0.60), myocardial infarction (risk ratio, 0.94; 95% CI, 0.30-2.99; p = 0.92), stroke (risk ratio, 1.15; 95% CI, 0.57-2.32; p = 0.70), acute renal failure (risk ratio, 0.98; 95% CI, 0.64-1.49; p = 0.91), infections (risk ratio, 1.23; 95% CI, 0.85-1.78; p = 0.27), or length of stay. There was no between-trial heterogeneity for any pooled analysis. Including four pediatric trials (456 participants) and 10 trials utilizing only intraoperative acute normovolemic hemodilution (872 participants) did not substantially change the results except that unlike the transfusion threshold trials, the hemodilution trials did not reduce the proportion of patients transfused (interaction p = 0.01). CONCLUSIONS: Further randomized controlled trials are necessary to determine the optimal transfusion strategy for patients undergoing cardiovascular surgery. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25167086/Transfusion_triggers_for_guiding_RBC_transfusion_for_cardiovascular_surgery:_a_systematic_review_and_meta_analysis__ L2 - https://dx.doi.org/10.1097/CCM.0000000000000548 DB - PRIME DP - Unbound Medicine ER -