Red Blood Cells Transfusion. Clinical Trial
The rationale for perioperative red blood cell (RBC) transfusion is based on the observation
that anemia is an independent risk factor for morbidity and mortality after cardiac
operations. However, transfusions have been associated with high rates of morbidity and
mortality in critically ill patients, and some recent studies have shown worse outcomes,
including increased occurrence of renal failure and infection, as well as respiratory,
cardiac, and neurological complications, in transfused compared with non transfused patients
after cardiac surgery. On the basis of past clinical observations, some authors have
suggested that hematocrit should be maintained at around 30% and hemoglobin concentration at
10 g/dL. Recently, however, this hemoglobin threshold has been reconsidered because of
recognized risks associated with transfusion and greater appreciation of the importance of
individual physiological responses to anemia. In a comparative trial of 428 patients
undergoing elective coronary artery bypass graft(CABG) surgery, Bracey et al reported that
reducing the hemoglobin trigger to 8 g/dL did not adversely affect patient outcomes and
resulted in lower costs. An important multicenter Canadian Study by Hebert et al that
included a large number of critically ill patients revealed that A restrictive strategy of
red-cell transfusion (hemoglobin concentration maintained between 7.0and 9.0g/dL) is at
least as effective as and possibly superior to a liberal transfusion (hemoglobin
concentration between 10 and 12 g/dL) strategy in critically ill patients, with the possible
exception of patients with acute myocardial infarction and unstable angina, in terms of
reducing organ dysfunction and mortality.
The investigators would like to determine whether a restrictive strategy of red-cell
transfusion and a liberal strategy produce equivalent results in orthopedic-oncology
patients undergoing surgery.
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Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment