Clinical trials evaluating red blood cell transfusion thresholds: An updated systematic review and with additional focus on patients with cardiovascular disease

@article{Carson2018ClinicalTE,
  title={Clinical trials evaluating red blood cell transfusion thresholds: An updated systematic review and with additional focus on patients with cardiovascular disease},
  author={Jeffrey L. Carson and Simon J. Stanworth and John H. Alexander and Nareg H Roubinian and Dean A. Fergusson and Darrell J. Triulzi and Shaun G. Goodman and Sunil V. Rao and Carolyn J Doree and Paul Hebert},
  journal={American Heart Journal},
  year={2018},
  volume={200},
  pages={96–101}
}

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References

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TLDR
The data support the use of a more liberal transfusion threshold (>80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease.
Health care-associated infection after red blood cell transfusion: a systematic review and meta-analysis.
TLDR
Among hospitalized patients, a restrictive RBC transfusion strategy was associated with a reduced risk of health care-associated infection compared with a liberal transfusions strategy, suggesting that implementing restrictive strategies may have the potential to lower the incidence of health Care- associated infection.
Transfusion requirements after cardiac surgery: the TRACS randomized controlled trial.
TLDR
Among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.
Transfusion Requirements in Surgical Oncology Patients: A Prospective, Randomized Controlled Trial
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A liberal erythrocyte transfusion strategy with a hemoglobin trigger of 9 g/dl was associated with fewer major postoperative complications in patients having major cancer surgery compared with a restrictive strategy.
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TLDR
A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs.
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In this small randomized trial, neither mortality nor the development of organ dysfunction was affected by the transfusion strategy, which suggests that a more restrictive approach to the transfusions of RBCs may be safe in critically ill patients.
Transfusion requirements in critical care : a pilot study
TLDR
It is suggested that a more restrictive approach to the transfusion of RBCs may be safe in critically ill patients, however, the study lacked power to detect small but clinically significant differences, and further investigations of R BC transfusion strategies are warranted.
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