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Randomized Controlled Trial
. 2015 Nov;150(5):1314-20.
doi: 10.1016/j.jtcvs.2015.07.051. Epub 2015 Jul 26.

A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery

Rosana Ely Nakamura  1 , Jean-Louis Vincent  2 , Julia Tizue Fukushima  1 , Juliano Pinheiro de Almeida  1 , Rafael Alves Franco  1 , Clarice Lee Park  1 , Eduardo Atsushi Osawa  1 , Carolina Maria Pinto Silva  1 , Jose Otavio Costa Auler Jr  1 , Giovanni Landoni  3 , Filomena Regina Barbosa Gomes Galas  1 , Roberto Kalil Filho  4 , Ludhmila Abrahao Hajjar  1
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Free article
Randomized Controlled Trial

A liberal strategy of red blood cell transfusion reduces cardiogenic shock in elderly patients undergoing cardiac surgery

Rosana Ely Nakamura et al. J Thorac Cardiovasc Surg. 2015 Nov.
Free article

Abstract

Objective: The aim of this study was to compare outcomes in patients undergoing cardiac surgery who are aged 60 years or more or less than 60 years after implementation of a restrictive or a liberal transfusion strategy.

Methods: This is a substudy of the Transfusion Requirements After Cardiac Surgery (TRACS) randomized controlled trial. In this subgroup analysis, we separated patients into those aged 60 years or more (elderly) and those aged less than 60 years randomized to a restrictive or a liberal strategy of red blood cell transfusion. The primary outcome was a composite defined as a combination of 30-day all-cause mortality and severe morbidity.

Results: Of the 502 patients included in the Transfusion Requirements After Cardiac Surgery study, 260 (51.8%) were aged 60 years or more and 242 (48.2%) were aged less than 60 years and were included in this study. The primary end point occurred in 11.9% of patients in the liberal strategy group and 16.8% of patients in the restrictive strategy group (P = .254) for those aged 60 years or more and in 6.8% of patients in the liberal strategy group and 5.6% of patients in the restrictive strategy group for those aged less than 60 years (P = .714). However, in the older patients, cardiogenic shock was more frequent in patients in the restrictive transfusion group (12.8% vs 5.2%, P = .031). Thirty-day mortality, acute respiratory distress syndrome, and acute renal injury were similar in the restrictive and liberal transfusion groups in both age groups.

Conclusions: Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy may result in an increased rate of cardiogenic shock in elderly patients undergoing cardiac surgery compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients.

Trial registration: ClinicalTrials.gov NCT01021631.

Keywords: cardiac surgery; cardiogenic shock; elderly; red blood cell transfusion.

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