{"id":397,"date":"2010-10-01T00:00:01","date_gmt":"2010-10-01T00:00:01","guid":{"rendered":"https:\/\/awge.doctime.es\/?p=397"},"modified":"2016-05-24T08:21:07","modified_gmt":"2016-05-24T06:21:07","slug":"awge-59","status":"publish","type":"post","link":"https:\/\/awge.doctime.es\/index.php\/2010\/10\/01\/awge-59\/","title":{"rendered":"Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial."},"content":{"rendered":"

JAMA
\nHajjar 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, Le\u00e3o WC, Almeida JP, Pomerantzeff PM, Dallan LO, Jatene FB, Stolf NA, Auler JO Jr.<\/p>\n

Context
\nPerioperative red blood cell transfusion is commonly used to address anemia,
\nan independent risk factor for morbidity and mortality after cardiac operations;
\nhowever, evidence regarding optimal blood transfusion practice in patients undergoing
\ncardiac surgery is lacking.
\nObjective To define whether a restrictive perioperative red blood cell transfusion
\nstrategy is as safe as a liberal strategy in patients undergoing elective cardiac surgery.
\nDesign, Setting, and Patients The Transfusion Requirements After Cardiac Surgery
\n(TRACS) study, a prospective, randomized, controlled clinical noninferiority trial
\nconducted between February 2009 and February 2010 in an intensive care unit at a
\nuniversity hospital cardiac surgery referral center in Brazil. Consecutive adult patients
\n(n=502) who underwent cardiac surgery with cardiopulmonary bypass were eligible;
\nanalysis was by intention-to-treat.
\nIntervention Patients were randomly assigned to a liberal strategy of blood transfusion
\n(to maintain a hematocrit\u000230%) or to a restrictive strategy (hematocrit\u000224%).
\nMain Outcome Measure Composite end point of 30-day all-cause mortality and
\nsevere morbidity (cardiogenic shock, acute respiratory distress syndrome, or acute renal
\ninjury requiring dialysis or hemofiltration) occurring during the hospital stay. The
\nnoninferiority margin was predefined at −8% (ie, 8% minimal clinically important increase
\nin occurrence of the composite end point).
\nResults Hemoglobin concentrations were maintained at ameanof 10.5 g\/dL(95%confidence
\ninterval [CI], 10.4-10.6) in the liberal-strategy group and 9.1 g\/dL (95% CI, 9.0-
\n9.2) in the restrictive-strategy group (P\u0003.001). A total of 198 of 253 patients (78%) in
\nthe liberal-strategy group and 118 of 249 (47%) in the restrictive-strategy group received
\na blood transfusion (P\u0003.001). Occurrence of the primary end point was similar between
\ngroups (10% liberal vs11%restrictive; between-group difference,1%[95% CI,−6%to
\n4%]; P=.85). Independent of transfusion strategy, the number of transfused red blood
\ncell units was an independent risk factor for clinical complications or death at 30 days (hazard
\nratio for each additional unit transfused, 1.2 [95% CI, 1.1-1.4]; P=.002).
\nConclusion Among patients undergoing cardiac surgery, the use of a restrictive perioperative
\ntransfusion strategy compared with a more liberal strategy resulted in noninferior
\nrates of the combined outcome of 30-day all-cause mortality and severe morbidity.<\/p>\n","protected":false},"excerpt":{"rendered":"