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Randomised controlled trial
A restrictive perioperative transfusion strategy does not increase all-cause mortality (30 days) or morbidity compared with a liberal approach in patients undergoing cardiac surgery
  1. Dimitrios Mikroulis1,
  2. Nikolaos Papanas1,
  3. Georgios Vretzakis2,3
  1. 1Cardiothoracic Surgery Department, Democritus University Thrace, University Hospitalof Alexandroupolis, Greece
  2. 2Internal Medicine Department,Democritus University Thrace,University Hospitalof Alexandroupolis, Greece
  3. 3Department of Anesthesiology, University Hospital of Larissa, Larissa, Greece
  1. Correspondence to: Dimitrios Mikroulis
    Democritus University of Thrace, University Hospital of Alexandroupolis, Dragana, Alexandroupolis PC 68100, Greece; dmikrou{at}med.duth.gr

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Context

Cardiac surgery is associated with a high rate of allogeneic blood transfusion (BT), varying from 40% to 90% in most centres. However, BT may be both beneficial and harmful. Severe anaemia is an independent risk factor for cardiac surgery morbidity and mortality, but BT substantially increases costs and is associated with adverse outcomes, including increased rates of infections, neurologic complications, renal failure and decreased in-hospital and long-term survival after cardiac operations. The decision for transfusion is often based on haemoglobin or haematocrit levels, but there are no evidence-based guidelines on transfusion triggers after cardiac surgery.1

Methods

A prospective, randomised, non-inferiority controlled trial was conducted at the Heart Institute of the University of Sao Paulo, Sao Paulo, Brazil, between February 2009 and February 2010, to define whether a restrictive perioperative BT strategy is as safe as a liberal one in cardiac surgery patients. After exclusion …

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