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Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open-label, randomized, blinded outcome evaluation trial.
Mistry, Nikhil; Shehata, Nadine; Carmona, Paula; Bolliger, Daniel; Hu, Raymond; Carrier, François M; Alphonsus, Christella S; Tseng, Elaine E; Royse, Alistair G; Royse, Colin; Filipescu, Daniela; Mehta, Chirag; Saha, Tarit; Villar, Juan C; Gregory, Alexander J; Wijeysundera, Duminda N; Thorpe, Kevin E; Jüni, Peter; Hare, Gregory M T; Ko, Dennis T; Verma, Subodh; Mazer, C David.
Afiliación
  • Mistry N; Department of Anesthesia, St. Michael's Hospital, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.
  • Shehata N; Division of Hematology, Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada.
  • Carmona P; Department of Anesthesia and Critical Care, Hospital Universitari and Politecnic La Fe, Valencia, Spain.
  • Bolliger D; Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland.
  • Hu R; Department of Anesthesia, Austin Hospital, Melbourne, Victoria, Australia.
  • Carrier FM; Department of Anesthesiology & Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montreal, Québec, Canada.
  • Alphonsus CS; Carrefour de l'innovation et santé des populations, Centre de recherche du CHUM, Montreal, Québec, Canada.
  • Tseng EE; Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
  • Royse AG; Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA.
  • Royse C; Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
  • Filipescu D; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
  • Mehta C; Department of Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
  • Saha T; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
  • Villar JC; Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio, USA.
  • Gregory AJ; Department of Cardiac Anaesthesia and Intensive Care Medicine, Emergency Institute for Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
  • Wijeysundera DN; Department of Cardiac Anaesthesia, Epic Hospital, Ahmedabad, India.
  • Thorpe KE; Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada.
  • Jüni P; Fundación Cardioinfantil-Instituto de Cardiología, Bogota, Colombia.
  • Hare GMT; Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
  • Ko DT; Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
  • Verma S; Department of Anesthesia, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
  • Mazer CD; Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Diabetes Obes Metab ; 24(3): 421-431, 2022 03.
Article en En | MEDLINE | ID: mdl-34747087
AIM: To characterize the association between diabetes and transfusion and clinical outcomes in cardiac surgery, and to evaluate whether restrictive transfusion thresholds are harmful in these patients. MATERIALS AND METHODS: The multinational, open-label, randomized controlled TRICS-III trial assessed a restrictive transfusion strategy (haemoglobin [Hb] transfusion threshold <75 g/L) compared with a liberal strategy (Hb <95 g/L for operating room or intensive care unit; or <85 g/L for ward) in patients undergoing cardiac surgery on cardiopulmonary bypass with a moderate-to-high risk of death (EuroSCORE ≥6). Diabetes status was collected preoperatively. The primary composite outcome was all-cause death, stroke, myocardial infarction, and new-onset renal failure requiring dialysis at 6 months. Secondary outcomes included components of the composite outcome at 6 months, and transfusion and clinical outcomes at 28 days. RESULTS: Of the 5092 patients analysed, 1396 (27.4%) had diabetes (restrictive, n = 679; liberal, n = 717). Patients with diabetes had more cardiovascular disease than patients without diabetes. Neither the presence of diabetes (OR [95% CI] 1.10 [0.93-1.31]) nor the restrictive strategy increased the risk for the primary composite outcome (diabetes OR [95% CI] 1.04 [0.68-1.59] vs. no diabetes OR 1.02 [0.85-1.22]; Pinteraction  = .92). In patients with versus without diabetes, a restrictive transfusion strategy was more effective at reducing red blood cell transfusion (diabetes OR [95% CI] 0.28 [0.21-0.36]; no diabetes OR [95% CI] 0.40 [0.35-0.47]; Pinteraction  = .04). CONCLUSIONS: The presence of diabetes did not modify the effect of a restrictive transfusion strategy on the primary composite outcome, but improved its efficacy on red cell transfusion. Restrictive transfusion triggers are safe and effective in patients with diabetes undergoing cardiac surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Procedimientos Quirúrgicos Cardíacos / Infarto del Miocardio Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Diabetes Obes Metab Asunto de la revista: ENDOCRINOLOGIA / METABOLISMO Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Procedimientos Quirúrgicos Cardíacos / Infarto del Miocardio Tipo de estudio: Clinical_trials / Etiology_studies Límite: Humans Idioma: En Revista: Diabetes Obes Metab Asunto de la revista: ENDOCRINOLOGIA / METABOLISMO Año: 2022 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido