Previous studies have reported that restrictive transfusion strategies are non-inferior compared to liberal strategies for cardiac surgery patients followed up to 90 days after surgery. Results from the Transfusion Requirements in Cardiac Surgery (TRICS) III trial, which examined six-month outcomes for cardiopulmonary bypass patients at a moderate to high risk for death, were recently reported in The New England Journal of Medicine. In this open-label, multi-country, non-inferiority trial, 5243 patients were randomized to a restrictive transfusion strategy (transfuse intraoperative or postoperative patients when hemoglobin falls below 7.5 g/dL) or liberal strategy (transfuse intraoperative or postoperative ICU patients when hemoglobin falls below 9.5 g/dL or when hemoglobin falls below 8.5 g/dL for non-ICU patients). For the primary composite outcome that included death from any cause, myocardial infarction, stroke, or new onset renal failure with dialysis within 6 months after surgery, a restrictive transfusion approach was non-inferior to a liberal approach (absolute risk difference, 0.22 percentage points; 95% CI, -1.95 to 2.39; P for non-inferiority = 0.006). These results may be inconclusive since they varied by age. Further clinical studies are warranted.
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