Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: Systematic review and meta-analysis

BMJ (Online)

Volumn 352, Issue , 2016, Pages

  Docherty, Annemarie B ^a,b   O'Donnell, Rob ^b   Brunskill, Susan ^c   Trivella, Marialena ^c   Doree, Carolyn ^d   Holst, Lars ^e   Parker, Martyn ^f   Gregersen, Merete ^g   De Almeida, Juliano Pinheiro ^h   Walsh, Timothy S ^a,b   Stanworth, Simon J ^c,i  

^a UNIVERSITY OF EDINBURGH   (United Kingdom)

^b ROYAL INFIRMARY OF EDINBURGH   (United Kingdom)

^c JOHN RADCLIFFE HOSPITAL   (United Kingdom)

^d UNIVERSITY OF OXFORD   (United Kingdom)

^e Rigshospitalet   (Denmark)

^f PETERBOROUGH CITY HOSPITAL   (United Kingdom)

^g AARHUS UNIVERSITY   (Denmark)

^h UNIVERSITY OF SÃO PAULO   (Brazil)

ⁱ UNIVERSITY OF OXFORD   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ACUTE CORONARY SYNDROME; ARTICLE; BLOOD TRANSFUSION; CARDIOVASCULAR DISEASE; CEREBROVASCULAR ACCIDENT; CORONARY ARTERY DISEASE; DISEASE PREDISPOSITION; HUMAN; INTERMETHOD COMPARISON; ISCHEMIC HEART DISEASE; LIBERAL BLOOD TRANSFUSION; MORTALITY; NON ST SEGMENT ELEVATION MYOCARDIAL INFARCTION; OUTCOME ASSESSMENT; PATIENT SAFETY; PERIPHERAL VASCULAR DISEASE; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); RESTRICTIVE BLOOD TRANSFUSION; ST SEGMENT ELEVATION MYOCARDIAL INFARCTION; SYSTEMATIC REVIEW; TRANSIENT ISCHEMIC ATTACK; ADULT; COMPARATIVE STUDY; COMPLICATION; META ANALYSIS; POSTOPERATIVE COMPLICATIONS; PROCEDURES; SURGERY; TREATMENT OUTCOME;

ACUTE CORONARY SYNDROME; ADULT; BLOOD TRANSFUSION; CARDIOVASCULAR DISEASES; HUMANS; POSTOPERATIVE COMPLICATIONS; RANDOMIZED CONTROLLED TRIALS AS TOPIC; SURGICAL PROCEDURES, OPERATIVE; TREATMENT OUTCOME;

EID: 84962189546     PISSN: 09598146     EISSN: 17561833     Source Type: Journal    
DOI: 10.1136/bmj.i1351     Document Type: Article

References (75)

1. British Heart Foundation. Cardiovascular Disease Statistics 2015. Oxford; 2015. https://www.bhf.org.uk/publications/statistics/cvd-stats-2015
2. Vincent JL, Baron J-F, Reinhart K, et al. ABC (Anemia and Blood Transfusion in Critical Care) Investigators. Anemia and blood transfusion in critically ill patients. JAMA 2002;288:1499-507.
3. Carson J, Duff A, Poses R, et al. Effect of anaemia and cardiovascular disease on surgical mortality and morbidity. Lancet 1996;348:1055-60.
4. Wu W-C, Rathore SS, Wang Y, Radford MJ, Krumholz HM. Blood transfusion in elderly patients with acute myocardial infarction. N Engl J Med 2001;345:1230-6.
5. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002;39:1780-6.
6. Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation 2005;111:2042-9.
7. Thygesen K, Alpert JS, Jaffe AS, et al. Joint ESC/ACCF/AHA/WHF Task Force for Universal Definition of Myocardial Infarction. Authors/Task Force Members Chairpersons; Biomarker Subcommittee; ECG Subcommittee; Imaging Subcommittee; Classification Subcommittee; Intervention Subcommittee; Trials & Registries Subcommittee; Trials & Registries Subcommittee; Trials & Registries Subcommittee; Trials & Registries Subcommittee; ESC Committee for Practice Guidelines (CPG); Document Reviewers. Third universal definition of myocardial infarction. J Am Coll Cardiol 2012;60:1581-98.
8. Ostermann M, Lo J, Toolan M, et al. A prospective study of the impact of serial troponin measurements on the diagnosis of myocardial infarction and hospital and six-month mortality in patients admitted to ICU with non-cardiac diagnoses. Crit Care 2014;18:R62.
9. Nagele P, Brown F, Gage BF, et al. High-sensitivity cardiac troponin T in prediction and diagnosis of myocardial infarction and long-term mortality after noncardiac surgery. Am Heart J 2013;166:325-332.e1.
10. Botto F, Alonso-Coello P, Chan MT, et al. Myocardial injury after noncardiac surgery: a large, international, prospective cohort study establishing diagnostic criteria, characteristics, predictors, and 30-day outcomes. Anesthesiology 2014;120:564-78.
11. Brunskill SJ, Millette SL, Shokoohi A, et al. Red blood cell transfusion for people undergoing hip fracture surgery. Cochrane Database Syst Rev 2015;4:CD009699.
12. Holst LB, Petersen MW, Haase N, Perner A, Wetterslev J. Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis. BMJ 2015;350:h1354.
13. Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev 2012;4:CD002042.
14. Association of Anaesthetists of Great Britain and Ireland. Blood Transfusion and the Anaesthetist: Red Cell Transfusion 2. London; 2008.
15. ∗. Ann Intern Med 2012;157:49-58.
16. Norfolk DD, ed. Joint UK blood transfusion and tissue transplantation services professional advisory committee. Handbook of Transfusion Medicine. TSO, 2013.
17. Retter A, Wyncoll D, Pearse R, et al. British Committee for Standards in Haematology. Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients. Br J Haematol 2013;160:445-64.
18. Patel NN, Avlonitis VS, Jones HE, Reeves BC, Sterne JA, Murphy GJ. Indications for red blood cell transfusion in cardiac surgery: a systematic review and meta-analysis. Lancet Haematol 2015;2:e543-53.
19. National Institute for Health and Clinical Excellence. Transfusion: NICE guideline NG24. 2015. http://www.nice.org.uk/guidance/ng24/evidence/full-guidance-2177160733
20. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.
21. Docherty A, O'Donnell R, Brunskill S, Doree C, Walsh TS, Stanworth S. Transfusion thresholds in patients with Cardiovascular Disease (non-cardiac surgery). PROSPERO. 2014. http://www.crd.york.ac.uk/PROSPERO/display-record.asp?ID=CRD42014014251
22. Wilkinson KL, Brunskill SJ, Dorée C, et al. The clinical effects of red blood cell transfusions: an overview of the randomized controlled trials evidence base. Transfus Med Rev 2011;25:145-155. e2.
23. Higgins J, Green S, (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration 2011. www.cochrane-handbook.org
24. Shunemann H, Oxman A, Vist G, Higgins J, Deeks J, Glasziou P. Interpreting results and drawing conclusions. In: The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions Version 510 [updated March 2011]. 2011.
25. The Cochrane Collaboration. Review Manager (RevMan). The Nordic Cochrane Centre, 2014.
26. Jairath V, Kahan BC, Gray A, et al. Restrictive versus liberal blood transfusion for acute upper gastrointestinal bleeding (TRIGGER): a pragmatic, open-label, cluster randomised feasibility trial. Lancet 2015;386:137-44.
27. Wu Q. Clinical research of restrictive transfusion in elderly patients undergoing orthopedic surgery. www.chictr.org.cn/showprojen. aspx?proj=8714.
28. Tay J, Tinmouth A, Fergusson D, Allan D. Transfusion of red cells in hematopoietic stem cell transplantation (TRIST): study protocol for a randomized controlled trial. Trials 2011;12:207.
29. Buckstein R. Red blood cell transfusion thresholds and QOL in MDS (EnhanceRBC). https://clinicaltrials.gov/ct2/show/NCT01079247.
30. Palmieri TL. A trial of restrictive versus traditional blood transfusion practices in burn patients. https://clinicaltrials.gov/ct2/show/NCT01079247.
31. Matot I. Restrictive versus liberal red cell transfusion strategy in orthopedic-oncology patients undergoing surgery-a randomized controlled study. https://clinicaltrials.gov/ct2/show/NCT01491308.
32. Grover M, Talwalkar S, Casbard A, et al. Silent myocardial ischaemia and haemoglobin concentration: a randomized controlled trial of transfusion strategy in lower limb arthroplasty. Vox Sang 2006;90:105-12.
33. Zheng H, Wu J-J, Wang J. Evaluation of effectiveness and analysis of goal-directed blood transfusion in peri-operation of major orthopedic surgery in elderly patients. Exp Ther Med 2013;5:511-6.
34. Webert KE, Cook RJ, Couban S, et al. A multicenter pilot-randomized controlled trial of the feasibility of an augmented red blood cell transfusion strategy for patients treated with induction chemotherapy for acute leukemia or stem cell transplantation. Transfusion 2008;48:81-91.
35. Prick BW, Jansen AJ, Steegers EA, et al. Transfusion policy after severe postpartum haemorrhage: a randomised non-inferiority trial. BJOG 2014;121:1005-14.
36. Nielsen K, Dahl B, Johansson PI, Henneberg SW, Rasmussen LS. Intraoperative transfusion threshold and tissue oxygenation: a randomised trial. Transfus Med 2012;22:418-25.
37. Liu DX, Liu J, Zhang F, Zhang Q-Y, Xie M, Zhu Z-Q. Randomized controlled study on safety and feasibility of transfusion trigger score of emergency operations. Chin Med J (Engl) 2015;128:1801-8.
38. Koshy M, Burd L, Wallace D, Moawad A, Baron J. Prophylactic red-cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study. N Engl J Med 1988;319:1447-52.
39. Haberkern CM, Neumayr LD, Orringer EP, et al. Cholecystectomy in sickle cell anemia patients: perioperative outcome of 364 cases from the National Preoperative Transfusion Study. Blood 1997;89:1533-42.
40. Bergamin F, Almeida J, Park C, Osawa E, Silva J, Galas F, et al. Transfusion requirements in septic shock patients: a randomized controlled trial. Crit Care 2014;18:112. http://link.springer.com/article/10.1186%2Fcc13302.
41. Blair SD, Janvrin SB, McCollum CN, Greenhalgh RM. Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg 1986;73:783-5.
42. Fortune JB, Feustel PJ, Saifi J, Stratton HH, Newell JC, Shah DM. Influence of hematocrit on cardiopulmonary function after acute hemorrhage. J Trauma 1987;27:243-9.
43. Lotke PA, Barth P, Garino J P, Cook EF. Predonated autologous blood transfusions after total knee arthroplasty: immediate versus delayed administration. J Arthroplasty 1999;14:647-50.
44. Robertson CS, Hannay HJ, Yamal J-M, et al. Epo Severe TBI Trial Investigators. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA 2014;312:36-47.
45. Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med 2013;368:11-21.
46. Zygun DA, Nortje J, Hutchinson PJ, Timofeev I, Menon DK, Gupta AK. The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med 2009;37:1074-8.
47. Colomo A, Hernandez-Gea V, Muniz-Diaz E, Madoz P, Aracil C, Alarez-Urturi C. Transfusion strategies in patients with cirrhosis and acute gastrointestinal bleeding[abstract]. Hepatology 2008;48(Suppl):413A.
48. Hochain P, Merle V, Tuil S, et al. Transfusion for variceal bleeding in cirrhotic patients[letter]. Gut 1996;38:154.
49. So-Osman C. A restrictive transfusion trigger is a method for blood saving in elective orthopaedic surgery[abstract]. Vox Sang 2004;87(Suppl 3):52.
50. Weiss GB, Patten E, Alperin JB, et al. Hypertransfusion for adult acute leukaemia[letter]. Lancet 1982;1:105.
51. Park SH, Nam E, Bang SM, Cho EK, Shin DB, Lee JH. A randomized trial of anemia correction with two different hemoglobin targets in the first-line chemotherapy of advanced gastric cancer. Cancer Chemother Pharmacol 2008;62:1-9.
52. Villarejo F, Rizzolo M, Lópéz E, Domeniconi G, Arto G, Apezteguia C. [Acute anemia in high digestive hemorrhage. Margins of security for their handling without transfusion of red globules]. Acta Gastroenterol Latinoam 1999;29:261-70.
53. Palmer J, Maciver C, Scott R, Picken M, McClelland D, Keating J, et al Hip fracture and transfusion trial (HATT) [abstract]. Transfus Med 1998;8:52.
54. Bush RL, Pevec WC, Holcroft JW. A prospective, randomized trial limiting perioperative red blood cell transfusions in vascular patients. Am J Surg 1997;174:143-8.
55. Carson JL, Terrin ML, Noveck H, et al. FOCUS Investigators. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med 2011;365:2453-62.
56. Carson JL, Brooks MM, Abbott JD, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J 2013;165:964-971. e1.
57. Cooper HA, Rao SV, Greenberg MD, et al. Conservative versus liberal red cell transfusion in acute myocardial infarction (the CRIT Randomized Pilot Study). Am J Cardiol 2011;108:1108-11.
58. Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409-17.
59. Walsh TS, Boyd JA, Watson D, et al. RELIEVE Investigators. Restrictive versus liberal transfusion strategies for older mechanically ventilated critically ill patients: a randomized pilot trial. Crit Care Med 2013;41:2354-63.
60. Carson JL, Terrin ML, Barton FB, et al. A pilot randomized trial comparing symptomatic vs. hemoglobin-level-driven red blood cell transfusions following hip fracture. Transfusion 1998;38:522-9.
61. Fan Y-X, Liu F-F, Jia M, et al. Comparison of restrictive and liberal transfusion strategy on postoperative delirium in aged patients following total hip replacement: a preliminary study. Arch Gerontol Geriatr 2014;59:181-5.
62. Hébert PC, Wells G, Marshall J, et al. Canadian Critical Care Trials Group. Transfusion requirements in critical care. A pilot study. JAMA 1995;273:1439-44.
63. Foss NB, Kristensen MT, Jensen PS, Palm H, Krasheninnikoff M, Kehlet H. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery. Transfusion 2009;49:227-34.
64. Mazza BF, Freitas FGR, Barros MMO, Azevedo LCP, Machado FR. Blood transfusions in septic shock: is 7.0 g/dL really the appropriate threshold? Rev Bras Ter Intensiva 2015;27:36-43.
65. Nielsen K, Johansson PI, Dahl B, et al. Perioperative transfusion threshold and ambulation after hip revision surgery - a randomized trial. BMC Anesthesiol 2014;14:89.
66. Parker MJ. Randomised trial of blood transfusion versus a restrictive transfusion policy after hip fracture surgery. Injury 2013;44:1916-8.
67. De Almeida JP, Vincent JL, Galas FR, et al. Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Anesthesiology 2015;122:29-38.
68. Holst LB, Haase N, Wetterslev J, et al. TRISS Trial Group Scandinavian Critical Care Trials Group. Lower versus higher hemoglobin threshold for transfusion in septic shock. N Engl J Med 2014;371:1381-91.
69. Gregersen M, Borris LC, Damsgaard EM. Postoperative blood transfusion strategy in frail, anemic elderly patients with hip fracture: the TRIFE randomized controlled trial. Acta Orthop 2015;86:363-72.
70. So-Osman C, Nelissen R, Te Slaa R, Coene L, Brand R. Brand A. A randomized comparison of transfusion triggers in elective orthopaedic surgery using leucocyte-depleted red blood cells. Vox Sang 2010;98:56-64.
71. Gregersen M, Damsgaard EM, Borris LC. Blood transfusion and risk of infection in frail elderly after hip fracture surgery: the TRIFE randomized controlled trial. Eur J Orthop Surg Traumatol. Springer Paris, 2015.
72. Deans KJ, Minneci PC, Suffredini AF, et al. Randomization in clinical trials of titrated therapies: unintended consequences of using fixed treatment protocols. Crit Care Med 2007;35:1509-16.
73. Walsh TS, McClelland DB, Lee RJ, et al. ATICS Study Group. Prevalence of ischaemic heart disease at admission to intensive care and its influence on red cell transfusion thresholds: multicentre Scottish Study. Br J Anaesth 2005;94:445-52.
74. Murphy GJ, Pike K, Rogers CA, et al. TITRe2 Investigators. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 2015;372:997-1008.
75. Fominskiy E, Putzu A, Monaco F, et al. Liberal transfusion strategy improves survival in perioperative but not in critically ill patients. A meta-analysis of randomised trials. Br J Anaesth 2015;115:511-9.