Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/27987
Title: Restrictive versus Liberal Transfusion in Patients with Diabetes Undergoing Cardiac Surgery: An Open-Label Randomized, Blinded Outcome Evaluation Trial.
Austin Authors: Mistry, Nikhil;Shehata, Nadine;Carmona, Paula;Bolliger, Daniel;Hu, Raymond T C ;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
Affiliation: Outcomes Research Consortium, The Cleveland Clinic, Cleveland, Ohio, USA
Department of Anesthesia, St. Michael's Hospital, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
Department of Anesthesiology & Department of Medicine, Critical Care Division, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
Carrefour de l'innovation et santé des populations, Centre de recherche du CHUM, Montreal, QC, Canada
Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia
Department of Surgery, The University of Melbourne and The Royal Melbourne Hospital, Royal Melbourne Hospital, Parkville, Victoria, Australia
Anaesthesia
Division of Adult Cardiothoracic Surgery, Department of Surgery, University of California San Francisco and San Francisco VA Medical Center, San Francisco, California, USA
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
Department of Anesthesia and Critical Care, Hospital Universitari and Politecnic La Fe, Valencia, Spain
Clinic for Anaesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland
Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa
Department of Cardiac Anaesthesia and Intensive Care Medicine, Emergency Institute for Cardiovascular Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Cardiac Anaesthesia, Epic Hospital, Ahmedabad, Gujarat, India
Department of Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada
Fundación Cardioinfantil-Instituto de Cardiología, Bogota; Universidad Autónoma de Bucaramanga, Bucaramanga, Columbia
Department of Anesthesiology, Perioperative and Pain Medicine, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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
Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
Department of Anesthesia, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Department of Physiology, University of Toronto, Toronto, Ontario, Canada
Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation University of Toronto; ICES, Toronto, Ontario, Canada
Division of Cardiac Surgery, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Department of Surgery, Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
Department of Anesthesia, St. Michael's Hospital, Li Ka Shing Knowledge Institute, Institute of Medical Sciences, Department of Physiology, University of Toronto, Toronto, Ontario, Canada
Issue Date: 2022
Date: 2021-11-07
Publication information: Diabetes, Obesity & Metabolism 2022; 24(3): 421-431
Abstract: 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. The multinational, open-label, randomized controlled TRICS-III trial assessed a restrictive transfusion strategy (hemoglobin [Hb] transfusion threshold <75 g/L) compared to a liberal strategy (Hb <95 g/L for operating room or ICU; 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. Of the 5092 patients analyzed, 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]) or 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  = 0.92). 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  = 0.04). 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. This article is protected by copyright. All rights reserved.
URI: https://ahro.austin.org.au/austinjspui/handle/1/27987
DOI: 10.1111/dom.14591
ORCID: 0000-0003-2566-4308
Journal: Diabetes, Obesity & Metabolism
PubMed URL: 34747087
Type: Journal Article
Appears in Collections:Journal articles

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