While a restrictive transfusion strategy has been advocated for most patients, a restrictive approach for cardiac surgery patients may put them at a greater risk of anemia-induced tissue hypoxia or worse outcomes. A recent multicenter, randomized trial published in The New England Journal of Medicine compared a restrictive threshold (transfuse when hemoglobin drops below 7.5 g/dL) to a liberal threshold for RBC transfusion (transfuse when hemoglobin drops below 9.5 g/dL in operating room or ICU or less than 8.5 g/dL otherwise) among 5243 cardiac surgery patients. Patients in the restrictive group were less likely to receive a transfusion and received fewer units on average than patients in the liberal group. Mortality, however, was similar in both groups—3.0% of patients died in the restrictive group compared to 3.6% in the liberal group (odds ratio, 0.85; 95% CI, 0.62 to 1.16). The non-inferiority of a restrictive approach to a liberal approach was robust even when considering myocardial infarctions, strokes, new-onset renal failure events in addition to death (11.4% vs 12.5%, odds ratio 0.90; 95% CI, 0.76 to 1.07; P<0.001 for non-inferiority). A restrictive approach to transfusions for cardiac surgery patients appears to be safe.
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Hi – the link for this article isn’t working. Also, I’m confused – is a restrictive threshold safe or does it put the patient at risk for hypoxia injuries? The summary seems to state both.
Thank you for your comment. We have updated the link. The restrictive transfusion threshold appears to be safe.