Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome.
BACKGROUND
There is controversy regarding the application of transfusion triggers in cardiac surgery. The goal of this study was to determine if lowering the hemoglobin threshold for red cell (RBC) transfusion to 8 g per dL after coronary artery bypass graft surgery would reduce blood use without adversely affecting patient outcome.


METHODS
Consecutive patients (n = 428) undergoing elective primary coronary artery bypass graft surgery were randomly assigned to two groups: study patients (n = 212) received RBC transfusions in the postoperative period if the Hb level was < 8 g per dL or if predetermined clinical conditions required RBC support, and control patients (n = 216) were treated according to individual physician's orders (hemoglobin levels < 9 g/dL as the institutional guideline). Multiple demographic, procedure-related, transfusion, laboratory, and outcome data were analyzed. Questionnaires were administered for patient self-assessment of fatigue and anemia.


RESULTS
Preoperative and operative clinical characteristics, as well as the intraoperative transfusion rate, were similar for both groups. There was a significant difference between the postoperative RBC transfusion rates in study (0.9 +/- 1.5 RBC units) and control (1.4 +/- 1.8 RBC units) groups (p = 0.005). There was no difference in clinical outcome, including morbidity and mortality rates, in the two groups; group scores for self-assessment of fatigue and anemia were also similar.


CONCLUSIONS
A lower Hb threshold of 8 g per dL does not adversely affect patient outcome. Moreover, RBC resources can be saved without increased risk to the patient.
Bracey
A W
AW
Department of Pathology, Texas Heart Institute/St. Luke's Episcopal Hospital and Prairie View A&M College of Nursing, Houston 77030, USA. abracey@msn.com
Radovancevic
R
R
Riggs
S A
SA
Houston
S
S
Cozart
H
H
Vaughn
W K
WK
Radovancevic
B
B
McAllister
H A
HA
Cooley
D A
DA
D000368:Aged; D001026:Coronary Artery Bypass / Q000401:mortality; D004056:Differential Threshold; D017707:Erythrocyte Transfusion; D005260:Female; D006306:Health Surveys; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D006454:Hemoglobins