Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis

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dc.contributor Sistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.author DOCHERTY, Annemarie B.
TRIVELLA, Marialena
DOREE, Carolyn
PARKER, Martyn
ALMEIDA, Juliano Pinheiro de FMUSP-HC
WALSH, Timothy S.
dc.date.issued 2016
dc.identifier.citation BMJ-BRITISH MEDICAL JOURNAL, v.352, article ID i1351, 11p, 2016
dc.identifier.issn 1756-1833
dc.identifier.uri http://observatorio.fm.usp.br/handle/OPI/14431
dc.description.abstract OBJECTIVE To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. DESIGN Systematic review and meta-analysis. DATA SOURCES Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. TRIAL SELECTION Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. DATA EXTRACTION AND SYNTHESIS Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios. MAIN OUTCOME MEASURES 30 day mortality, and cardiovascular events. RESULTS 41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n= 3033) were included for meta-analysis (restrictive transfusion, n= 1514 patients; liberal transfusion, n= 1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P= 0.50), with little heterogeneity (I-2= 14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P= 0.01, I-2= 0%). CONCLUSIONS The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (> 80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease.
dc.description.sponsorship · Cancer Research UK
dc.language.iso eng
dc.relation.ispartof BMJ-British Medical Journal
dc.rights restrictedAccess
dc.subject.other randomized-controlled-trial; blood-cell transfusion; critically-ill patients; traumatic brain-injury; hip fracture surgery; myocardial-infarction; elderly-patients; cardiac-surgery; clinical-trial; acute-leukemia
dc.title Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis
dc.type article
dc.rights.holder Copyright BMJ PUBLISHING GROUP
dc.identifier.doi 10.1136/bmj.i1351
dc.identifier.pmid 27026510
dc.type.category review
dc.type.version publishedVersion
hcfmusp.author ALMEIDA, Juliano Pinheiro de:HC:ICESP
hcfmusp.author.external · DOCHERTY, Annemarie B.:Univ Edinburgh, Ctr Inflammat Res, Edinburgh, Midlothian, Scotland; Royal Infirm Edinburgh NHS Trust, Crit Care Dept, Edinburgh, Midlothian, Scotland
· O'DONNELL, Rob:Royal Infirm Edinburgh NHS Trust, Crit Care Dept, Edinburgh, Midlothian, Scotland
· BRUNSKILL, Susan:John Radcliffe Hosp, NHS Blood & Transplant, Systemat Review Initiat, Oxford OX3 9DU, England
· TRIVELLA, Marialena:John Radcliffe Hosp, NHS Blood & Transplant, Systemat Review Initiat, Oxford OX3 9DU, England
· DOREE, Carolyn:Univ Oxford, Ctr Stat Med, Oxford, England
· HOLST, Lars:Copenhagen Univ Hosp, Rigshosp, Dept Intens Care, Copenhagen, Denmark
· PARKER, Martyn:Peterborough & Stamford Hosp NHS Trust, Dept Orthopaed, Peterborough, Cambs, England
· GREGERSEN, Merete:Aarhus Univ, Dept Geriatr, Aarhus, Denmark
· WALSH, Timothy S.:Univ Edinburgh, Ctr Inflammat Res, Edinburgh, Midlothian, Scotland; Royal Infirm Edinburgh NHS Trust, Crit Care Dept, Edinburgh, Midlothian, Scotland
· STANWORTH, Simon J.:John Radcliffe Hosp, NHS Blood & Transplant, Systemat Review Initiat, Oxford OX3 9DU, England; NHS Blood & Transplant Oxford Univ Hosp NHS Trust, Dept Haematol, Oxford, England
hcfmusp.origem.id 2-s2.0-84962189546
hcfmusp.origem.id WOS:000373491500001
hcfmusp.publisher.city LONDON
hcfmusp.publisher.country ENGLAND
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dc.description.index MEDLINE
hcfmusp.citation.scopus 95
hcfmusp.citation.wos 84
hcfmusp.affiliation.country Brasil
hcfmusp.affiliation.country Escócia
hcfmusp.affiliation.country Inglaterra
hcfmusp.affiliation.country Dinamarca
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