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FOCUS: 10 g/dL transfusion strategy in postsurgical patients offers no improvement in MI or death
The amounts of blood units transfused differed between treatment groups.
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American Heart Association Scientific Sessions 2009
A 10 g/dL blood transfusion strategy to stabilize postsurgical hemoglobin levels was not significantly different from a symptomatic transfusion strategy in elderly patients, study results suggested.
Researchers enrolled 2,016 patients undergoing surgical repair for hip fractures in the study and randomly assigned them to receive either a blood transfusion strategy designed to maintain hemoglobin levels >10 g/dL or a symptomatic strategy (n=1,009). Patients were included if their hemoglobin levels were <10 g/dL at three days after surgery. Patients were elderly (mean age, 81.6 ± 8.9 years) and most had CVD (62.9%). The researchers reported the secondary study outcomes, which included in-hospital death, MI or unstable angina.
According to the study results, 977 patients (97%) in the non-symptomatic strategy group received transfusions, compared with 419 patients (41.5%) in the symptomatic group. There were no differences between the 10 g/dL treatment group and symptomatic treatment group for elevated troponin levels (6.2% vs. 5.9%; OR=1.06; 99% CI, 0.65-1.71), in-hospital MI (2.3% vs. 3.8%; OR=0.60; 99% CI, 0.30-1.19), in-hospital mortality (2.0% vs. 1.4%; OR=1.44; 99% CI, 0.58-3.56), cardiac mortality (0.7% vs. 0.5%; OR=1.41; 99% CI, 0.31-6.39) or the combined endpoint of MI, unstable angina or death (4.3% vs. 5.2%; OR=0.82; 99% CI, 0.48-1.42). There were 1,866 transfused blood units in the 10 g/dL group vs. 652 units in the symptomatic group.
“Transfusion for symptoms or hemoglobin levels <8 g/dL conserve blood, and there was a large difference in the amount of blood used between the two groups,” Jeffrey L. Carson, MD, a professor of medicine at Robert Wood Johnson Medical School in Piscataway, N.J., said in his presentation. “No statistically significant differences were found for in-hospital MI, unstable angina or death, or for isolated troponin concentrations.” – by Eric Raible
For more information:
- Carson J. LBCT02 # 116. Presented at: American Heart Association Scientific Sessions; Nov. 14-18, 2009; Orlando.
At this juncture, there will be more than one trigger that will continue to influence clinicians faced with the problem of low hemoglobin after hip surgery, and it will need to be placed in the context of what the patient brings to the table, how balanced their portfolio is, and how then to proceed logically doing the right thing at the right time.
– Paul W. Armstrong, MD
Professor of Medicine
University of Alberta, Edmonton,
Canada
