Address reprint requests to: Arthur W. Bracey, MD, Department of Pathology, St. Luke's Episcopal Hospital, 6720 Bertner Avenue, Houston, TX 77030; e-mail: firstname.lastname@example.org.
Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome
Article first published online: 25 APR 2002
Volume 39, Issue 10, pages 1070–1077, October 1999
How to Cite
Bracey, A.W., Radovancevic, R., Riggs, S.A., Houston, S., Cozart, H., Vaughn, W.K., Radovancevic, B., McAllister, H.A. and Cooley, D.A. (1999), Lowering the hemoglobin threshold for transfusion in coronary artery bypass procedures: effect on patient outcome. Transfusion, 39: 1070–1077. doi: 10.1046/j.1537-2995.1999.39101070.x
- Issue published online: 25 APR 2002
- Article first published online: 25 APR 2002
- Received: 30 1998; Revised: 08 March 1999; Accepted: 22 March 1999
- CABG = coronary artery bypass grafting;
- CPB = cardiopulmonary bypass;
- FACT-An = FACT-Anemia;
- FACT-F = Functional Assessment of Cancer Therapy-Fatigue;
- Hb = hemoglobin;
- ICU = intensive care unit;
- RBC(s) = red cell(s);
- THI = Texas Heart Institute
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.
STUDY DESIGN AND 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.