BACKGROUND: The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. METHODS: We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of <8 g per deciliter). The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up. RESULTS: A median of 2 units of red cells were transfused in the liberal-strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, -3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, -0.9%; 99% CI, -3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, -1.9 to 4.0). The rates of other complications were similar in the two groups. CONCLUSIONS: A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.).
RCT Entities:
BACKGROUND: The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. METHODS: We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of <8 g per deciliter). The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up. RESULTS: A median of 2 units of red cells were transfused in the liberal-strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, -3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, -0.9%; 99% CI, -3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, -1.9 to 4.0). The rates of other complications were similar in the two groups. CONCLUSIONS: A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.).
Authors: Paul A Carless; David A Henry; Jeffrey L Carson; Paul Pc Hebert; Brian McClelland; Katharine Ker Journal: Cochrane Database Syst Rev Date: 2010-10-06
Authors: Jeffrey L Carson; Michael L Terrin; Jay Magaziner; Bernard R Chaitman; Fred S Apple; David A Heck; David Sanders Journal: Transfusion Date: 2006-12 Impact factor: 3.157
Authors: P C Hébert; G Wells; M A Blajchman; J Marshall; C Martin; G Pagliarello; M Tweeddale; I Schweitzer; E Yetisir Journal: N Engl J Med Date: 1999-02-11 Impact factor: 91.245
Authors: P C Hébert; E Yetisir; C Martin; M A Blajchman; G Wells; J Marshall; M Tweeddale; G Pagliarello; I Schweitzer Journal: Crit Care Med Date: 2001-02 Impact factor: 7.598
Authors: María García-Roa; María Del Carmen Vicente-Ayuso; Alejandro M Bobes; Alexandra C Pedraza; Ataúlfo González-Fernández; María Paz Martín; Isabel Sáez; Jerard Seghatchian; Laura Gutiérrez Journal: Blood Transfus Date: 2017-05 Impact factor: 3.443
Authors: Jeffrey L Carson; Frederick Sieber; Donald Richard Cook; Donald R Hoover; Helaine Noveck; Bernard R Chaitman; Lee Fleisher; Lauren Beaupre; William Macaulay; George G Rhoads; Barbara Paris; Aleksandra Zagorin; David W Sanders; Khwaja J Zakriya; Jay Magaziner Journal: Lancet Date: 2014-12-09 Impact factor: 79.321