Restrictive compared with liberal red cell transfusion strategies in cardiac surgery: A meta-analysis

European Heart Journal

Volumn 40, Issue 13, 2019, Pages 1081-1088

  Shehata, Nadine ^a   Mistry, Nikhil ^b   Da Costa, Bruno R ^c,d   Pereira, Tiago V ^c   Whitlock, Richard ^e   Curley, Gerard F ^f   Scott, David A ^g   Hare, Gregory M T ^c   Jüni, Peter ^c   Mazer, C David ^c  

^a UNIVERSITY OF TORONTO   (Canada)

^b ST MICHAEL'S HOSPITAL   (Canada)

^c ST MICHAEL'S HOSPITAL   (Canada)

^d UNIVERSITY OF BERN   (Switzerland)

^e MCMASTER UNIVERSITY   (Canada)

^f ROYAL COLLEGE OF SURGEONS IN IRELAND   (Ireland)

^g UNIVERSITY OF MELBOURNE   (Australia)

Author keywords

Blood transfusion; Cardiac surgery; Thresholds

Indexed keywords

HEMOGLOBIN;

ALL CAUSE MORTALITY; ARTICLE; CEREBROVASCULAR ACCIDENT; ERYTHROCYTE TRANSFUSION; HEART ARRHYTHMIA; HEART INFARCTION; HEART SURGERY; HUMAN; INFECTION; INTENSIVE CARE; KIDNEY FAILURE; LENGTH OF STAY; META ANALYSIS; OPERATIVE BLOOD LOSS; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); SEQUENTIAL ANALYSIS; SYSTEMATIC REVIEW; ADULT; ANEMIA; CHILD; COMPARATIVE STUDY; COMPLICATION; HYPOXIA; MORTALITY; ODDS RATIO; PROCEDURES;

ADULT; ANEMIA; CARDIAC SURGICAL PROCEDURES; CHILD; ERYTHROCYTE TRANSFUSION; HEMOGLOBINS; HUMANS; HYPOXIA; INFECTIONS; MYOCARDIAL INFARCTION; ODDS RATIO; RANDOMIZED CONTROLLED TRIALS AS TOPIC; RENAL INSUFFICIENCY; STROKE;

EID: 85063991847     PISSN: 0195668X     EISSN: 15229645     Source Type: Journal    
DOI: 10.1093/eurheartj/ehy435     Document Type: Article

References (33)

1. Hung M, Ortmann E, Besser M, Martin-Cabrera P, Richards T, Ghosh M, Bottrill F, Collier T, Klein AA. A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients. Heart 2015;101:107-112.
2. Karkouti K, Wijeysundera DN, Beattie WS. Risk associated with preoperative anemia in cardiac surgery: a multicenter cohort study. Circulation 2008;117: 478-484.
3. Hare GM, Freedman J, Mazer CD. Review article: risks of anemia and related management strategies: can perioperative blood management improve patient safety? Can J Anaesth 2013;60:168-175.
4. Koch CG, Li L, Duncan AI, Mihaljevic T, Cosgrove DM, Loop FD, Starr NJ, Blackstone EH. Morbidity and mortality risk associated with red blood cell and blood-component transfusion in isolated coronary artery bypass grafting. Crit Care Med 2006;34:1608-1616.
5. Koch CG, Li L, Duncan AI, Mihaljevic T, Loop FD, Starr NJ, Blackstone EH. Transfusion in coronary artery bypass grafting is associated with reduced longterm survival. Ann Thorac Surg 2006;81:1650-1657.
6. Silliman CC, Ambruso DR, Boshkov LK. Transfusion-related acute lung injury. Blood 2005;105:2266-2273.
7. Vlaar AP, Hofstra JJ, Determann RM, Veelo DP, Paulus F, Levi M, Zeerleder S, Vroom MB, Schultz MJ, Juffermans NP. Transfusion-related acute lung injury in cardiac surgery patients is characterized by pulmonary inflammation and coagulopathy: a prospective nested case-control study. Crit Care Med 2012;40: 2813-2820.
8. Vlaar AP, Hofstra JJ, Determann RM, Veelo DP, Paulus F, Kulik W, Korevaar J, de Mol BA, Koopman MM, Porcelijn L, Binnekade JM, Vroom MB, Schultz MJ, Juffermans NP. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study. Blood 2011;117:4218-4225.
9. Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood 2009;113:3406-3417.
10. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E. 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;340:409-417.
11. Murphy GJ, Pike K, Rogers CA, Wordsworth S, Stokes EA, Angelini GD, Reeves BC. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med 2015; 372:997-1008.
12. Mazer CD, Whitlock RP, Fergusson DA, Hall J, Belley-Cote E, Connolly K, Khanykin B, Gregory AJ, de Médicis É, McGuinness S, Royse A, Carrier FM, Young PJ, Villar JC, Grocott HP, Seeberger MD, Fremes S, Lellouche F, Syed S, Byrne K, Bagshaw SM, Hwang NC, Mehta C, Painter TW, Royse C, Verma S, Hare GMT, Cohen A, Thorpe KE, Jüni P, Shehata N. Restrictive or liberal redcell transfusion for cardiac surgery. N Engl J Med 2017;377:2133-2144.
13. Curley GF, Shehata N, Mazer CD, Hare GM, Friedrich JO. Transfusion triggers for guiding RBC transfusion for cardiovascular surgery: a systematic review and meta-analysis. Crit Care Med 2014;42:2611-2624.
14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009; 151:264-269, w64.
15. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
16. Kwon D, Reis IM. Simulation-based estimation of mean and standard deviation for meta-analysis via Approximate Bayesian Computation (ABC). BMC Med Res Methodol 2015;15:61.
17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7: 177-188.
18. Sedgwick P. Meta-analyses: how to read a funnel plot. BMJ 2013;346:f1342.
19. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327:557-560.
20. Wetterslev J, Thorlund K, Brok J, Gluud C. Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis. J Clin Epidemiol 2008; 61:64-75.
21. Koch CG, Sessler DI, Mascha EJ, Sabik JF, Li L, Duncan AI, Zimmerman NM, Blackstone EH. A randomized clinical trial of red blood cell transfusion triggers in cardiac surgery. Ann Thorac Surg 2017;104:1243-1250.
22. Cholette JM, Swartz MF, Rubenstein J, Henrichs KF, Wang H, Powers KS, Daugherty LE, Alfieris GM, Gensini F, Blumberg N. Outcomes using a conservative versus liberal red blood cell transfusion strategy in infants requiring cardiac operation. Ann Thorac Surg 2017;103:206-214.
23. de Gast-Bakker DH, de Wilde RB, Hazekamp MG, Sojak V, Zwaginga JJ, Wolterbeek R, de Jonge E, Gesink-van der Veer BJ. Safety and effects of two red blood cell transfusion strategies in pediatric cardiac surgery patients: a randomized controlled trial. Intensive Care Med 2013;39:2011-2019.
24. Shehata N, Burns LA, Nathan H, Hebert P, Hare GM, Fergusson D, Mazer CD. A randomized controlled pilot study of adherence to transfusion strategies in cardiac surgery. Transfusion 2012;52:91-99.
25. Cholette JM, Rubenstein JS, Alfieris GM, Powers KS, Eaton M, Lerner NB. Children with single-ventricle physiology do not benefit from higher hemoglobin levels post cavopulmonary connection: results of a prospective, randomized, controlled trial of a restrictive versus liberal red-cell transfusion strategy. Pediatr Crit Care Med 2011;12:39-45.
26. Hajjar LA, Vincent JL, Galas FR, Nakamura RE, Silva CM, Santos MH, Fukushima J, Kalil Filho R, Sierra DB, Lopes NH, Mauad T, Roquim AC, Sundin MR, Leao WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr. Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial. JAMA 2010;304:1559-1567.
27. Willems A, Harrington K, Lacroix J, Biarent D, Joffe AR, Wensley D, Ducruet T, Hebert PC, Tucci M. Comparison of two red-cell transfusion strategies after pediatric cardiac surgery: a subgroup analysis. Crit Care Med 2010;38:649-656.
28. Bracey AW, Radovancevic R, Riggs SA, Houston S, Cozart H, Vaughn WK, Radovancevic B, McAllister HA Jr, Cooley DA. Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion 1999;39:1070-1077.
29. Chkhaidze M, Metreveli I, Tsintsadze A. Comparison of two RBC transfusion strategies in pediatric cardiac surgery patients: 6AP2-3. Eur J Anaesthesiol 2014;31:92.
30. Chkhaidze M, Metreveli I, Tsintsadze A. Optimal strategy of RBC transfusion for patients after cardiac surgery. Int Care Med 2013;39:S388.
31. Laine A, Niemi T, Schramko A. Transfusion threshold of hemoglobin 80 g/L is comparable to 100 g/L in terms of bleeding in cardiac surgery: a prospective randomized study. J Cardiothorac Vasc Anesth 2018;32:131-139.
32. 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 metaanalysis. Lancet Haematol 2015;2:e543-e553.
33. 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.