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Restricting Blood Transfusions OK in Cardiac Surgery

THURSDAY, June 20, 2019 -- For high-risk patients undergoing cardiac surgery with cardiopulmonary bypass, a restrictive approach to red blood cell transfusions leads to fewer transfusions than a liberal approach, with no increase in the risk for acute kidney injury (AKI), according to a study published online June 20 in the Journal of the American Society of Nephrology.

Amit X. Garg, M.D., Ph.D., from the London Health Sciences Centre and Western University in Canada, and colleagues compared a restrictive versus liberal threshold for red blood cell transfusion among 4,531 patients undergoing cardiac surgery with cardiopulmonary bypass with moderate-to-high risk of perioperative death.

The researchers found that compared with the liberal-threshold group, patients in the restrictive-threshold group received significantly fewer transfusions (1.8 versus 2.9 on average, or 38 percent fewer). AKI occurred in 27.7 and 27.9 percent of patients in the restrictive-threshold and liberal-threshold groups, respectively. Among patients with preoperative chronic kidney disease, AKI occurred in 33.6 and 32.5 percent of patients in the restrictive-threshold and liberal-threshold groups, respectively.

"With over 20 million cardiac surgeries performed worldwide each year -- with it being one of the more common reasons for using blood in the hospital and an average of about three units of red blood cells used per patient -- this suggests that approximately 20 million units of blood transfusions could be avoided each year without influencing the chance that a patient will develop postoperative kidney injury," Garg said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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Posted: June 2019

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