Low vs high hemoglobin trigger for transfusion in vascular surgery: a randomized clinical feasibility trial
| Autor: | Klaus V. Marcussen, Anette Mortensen, Per Winkel, Benedicte G. U. Ramsing, Dorthe Hellemann, Jørn Wetterslev, Ole Birger Pedersen, Henning B. Nielsen, Saeid Shahidi, Anders Møller, Janus Christian Jakobsen |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Immunology 030204 cardiovascular system & hematology Biochemistry law.invention 03 medical and health sciences Hemoglobins 0302 clinical medicine Randomized controlled trial Clinical Protocols Interquartile range law Medicine Humans 030212 general & internal medicine business.industry Hazard ratio Cell Biology Hematology Perioperative Vascular surgery Middle Aged medicine.disease Abdominal aortic aneurysm Red blood cell medicine.anatomical_structure Anesthesia Feasibility Studies Female Hemoglobin business Erythrocyte Transfusion Vascular Surgical Procedures |
| Zdroj: | Møller, A, Nielsen, H B, Wetterslev, J, Pedersen, O B, Hellemann, D, Winkel, P, Marcussen, K V, Ramsing, B G U, Mortensen, A, Jakobsen, J C & Shahidi, S 2019, ' Low vs high hemoglobin trigger for transfusion in vascular surgery : a randomized clinical feasibility trial ', Blood, vol. 133, no. 25, pp. 2639-2650 . https://doi.org/10.1182/blood-2018-10-877530 |
| ISSN: | 1528-0020 |
| DOI: | 10.1182/blood-2018-10-877530 |
| Popis: | Current guidelines advocate to limit red blood cell (RBC) transfusion during surgery, but the feasibility and safety of such a strategy remain unclear, as the majority of evidence is based on postoperatively stable patients. We assessed the effects of a protocol aiming to restrict RBC transfusion throughout hospitalization for vascular surgery. Fifty-eight patients scheduled for lower limb bypass or open abdominal aortic aneurysm repair were randomly assigned, on hemoglobin drop below 9.7 g/dL, to either a low-trigger (hemoglobin < 8.0 g/dL) or a high-trigger (hemoglobin < 9.7 g/dL) group for RBC transfusion. Near-infrared spectroscopy assessed intraoperative oxygen desaturation in brain and muscle. Explorative outcomes included nationwide registry data on death and major vascular complications. The primary outcome, mean hemoglobin within 15 days of surgery, was significantly lower in the low-trigger group, at 9.46 vs 10.33 g/dL in the high-trigger group (mean difference, −0.87 g/dL; P = .022), as were units of RBCs transfused (median [interquartile range (IQR)], 1 [0-2] vs 3 [2-6]; P = .0015). Although the duration and magnitude of cerebral oxygen desaturation increased in the low-trigger group (median [IQR], 421 [42-888] vs 127 [11-331] minutes × %; P = .0036), muscle oxygenation was unaffected. The low-trigger group associated to a higher rate of death or major vascular complications (19/29 vs 8/29; hazard ratio, 3.20; P = .006) and fewer days alive outside the hospital within 90 days (median [IQR], 76 [67-82] vs 82 [76-84] days; P = .049). In conclusion, a perioperative protocol restricting RBC transfusion successfully separated hemoglobin levels and RBC units transfused. Exploratory outcomes suggested potential harm with the low-trigger group and warrant further trials before such a strategy is universally adopted. This trial was registered at www.clinicaltrials.gov as #NCT02465125. |
| Databáze: | OpenAIRE |
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