Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open‐label, randomized, blinded outcome evaluation trial. Issue 3 (17th November 2021)

• Record Type: Journal Article
• Authors: Mistry, Nikhil; Shehata, Nadine; Carmona, Paula; Bolliger, Daniel; Hu, Raymond; 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
• Is Part Of: Diabetes, obesity & metabolism. Volume 24:Issue 3(2022)
• Page Start: 421
• Page End: 431
• Publication Date: 2021-11-17
• Subjects: cardiovascular disease -- clinical trial; Diabetes -- Periodicals; Obesity -- Periodicals; Metabolism -- Disorders -- Periodicals; Clinical pharmacology -- Periodicals; 616.462
• DOI: 10.1111/dom.14591
• Languages: English
• ISSNs: 1462-8902

Abstract

Abstract: Aim: 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. Materials and Methods: The multinational, open‐label, randomized controlled TRICS‐III trial assessed a restrictive transfusion strategy (haemoglobin [Hb] transfusion threshold <75 g/L) compared with a liberal strategy (Hb <95 g/L for operating room or intensive care unit; 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. Results: Of the 5092 patients analysed, 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]) nor 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]; P interaction = .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]; P interaction = .04). Conclusions: 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.