A comparison of restrictive versus liberal transfusion thresholds to correct anaemia after cardiac surgery showed no differences in morbidity and total health-care costs. Patients allocated to a restrictive transfusion threshold (haemoglobin level <7.5 g/dl, n = 1,000) or a liberal threshold (haemoglobin level <9 g/dl, n = 1,003) had similar rates of the primary outcome of serious infection or ischaemic events within 3 months (35.1% vs 33.0%; OR 1.11, 95% CI 0.91–1.34, P = 0.30). Mortality was higher in the restrictive-threshold group than in the liberal-threshold group (4.2% vs 2.6%; HR 1.64, 95% CI 1.00–2.67; P = 0.045). Total health-care costs up to 3 months after surgery were similar in the two groups. Although restrictive thresholds require fewer units of red blood cells, the increased mortality in the restrictive-threshold group observed in this study raises concerns.
References
Murphy, G. J. et al. Liberal or restrictive transfusion after cardiac surgery. N. Engl. J. Med. 372, 997–1008 (2015)
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Restrictive transfusion threshold not superior to liberal threshold after cardiac surgery. Nat Rev Cardiol 12, 261 (2015). https://doi.org/10.1038/nrcardio.2015.54
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DOI: https://doi.org/10.1038/nrcardio.2015.54