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There are no prospective studies comparing outcomes between restrictive or liberal strategies in cardiac surgery. This study is a double-blind randomized study to determine whether a restrictive strategy of red cell transfusion and a liberal strategy produced equivalent results in patients submitted to cardiac surgery.
Until November 2009 we enrolled 380 patients undergoing elective cardiac surgery and randomly assigned 185 patients to a restrictive strategy of transfusion, in which red cells were transfused if the hematocrit concentration dropped below 24%, and 195 patients to a liberal strategy, in which transfusions were given when the hematocrit fell below 30%. Both transfusion strategies were followed into the operative room and during the ICU stay. We compared the rates of complications and death from all causes during the hospital stay and clinical outcomes of patients after 90 days. Adult patients, after written informed consent, were allocated if they would be submitted to elective primary surgery or were redone adult cardiac surgical patients for coronary artery bypass grafting, valve procedure or combined procedures.
Overall, hospital mortality was similar in the two groups (4.7% vs 5.3%, P = 0.11). The rates of complications were similar in the two groups (28.3% in the restrictive-strategy group and 26.1% in the liberal-strategy group, P = 0.33). The ICU stay was significantly lower in the restrictive-strategy group (2.2 days vs 4.1 days, P = 0.05). There was no difference in 90-day mortality between groups.
A restrictive strategy of red cell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in patients submitted to cardiac surgery.