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
| العنوان: | 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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| المؤلفون: | Susan J Brunskill, Timothy S. Walsh, Annemarie B Docherty, Rob O’Donnell, Juliano Pinheiro de Almeida, Martyn J. Parker, Marialena Trivella, Simon J. Stanworth, Carolyn Doree, Merete Gregersen, Lars B. Holst |
| المصدر: | The BMJ Docherty, A B, O'Donnell, R, Brunskill, S, Trivella, M, Doree, C, Holst, L, Parker, M, Gregersen, M, de Almeida, J P, Walsh, T S & Stanworth, S J 2016, ' 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 ', British Medical Journal (BMJ), vol. 352, i1351 . https://doi.org/10.1136/bmj.i1351Test |
| سنة النشر: | 2016 |
| مصطلحات موضوعية: | Adult, medicine.medical_specialty, Acute coronary syndrome, Blood transfusion, medicine.medical_treatment, TRAUMATIC BRAIN-INJURY, HIP FRACTURE SURGERY, 030204 cardiovascular system & hematology, law.invention, CLINICAL-TRIAL, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Internal medicine, medicine, Humans, Blood Transfusion, 030212 general & internal medicine, Myocardial infarction, ACUTE-LEUKEMIA, Acute Coronary Syndrome, Intensive care medicine, ELDERLY-PATIENTS, Randomized Controlled Trials as Topic, business.industry, Research, General Medicine, medicine.disease, Confidence interval, Clinical trial, Treatment Outcome, MYOCARDIAL-INFARCTION, Cardiovascular Diseases, Meta-analysis, Relative risk, Surgical Procedures, Operative, RANDOMIZED-CONTROLLED-TRIAL, business, BLOOD-CELL TRANSFUSION, CRITICALLY-ILL PATIENTS, CARDIAC-SURGERY |
| الوصف: | OBJECTIVETo compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery.DESIGNSystematic review and meta-analysis.DATA SOURCESRandomised 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 SELECTIONPublished and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease.DATA EXTRACTION AND SYNTHESISData 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 MEASURES30 day mortality, and cardiovascular events.RESULTS41 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%).CONCLUSIONSThe 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. |
| وصف الملف: | application/pdf |
| تدمد: | 1756-1833 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::e44ff1da02a6f15adda82326d3f96647Test https://pubmed.ncbi.nlm.nih.gov/27026510Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....e44ff1da02a6f15adda82326d3f96647 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 17561833 |
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