Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk

作者：Panos Kougias, Sherene Sharath, Min Zhan, Jeffrey L. Carson, Leslie E. Norman, Zhibao Mi, Rupsi Pal, Hasan Haldun Dosluoglu, John Gregory Modrall, George A. Sarosi, Peter R. Nelson, Shipra Arya, Alexandra A. Scrymgeour, Jade Ollison, Lawrence A. Calais, Vijay Nambi, L. Parker Gregg, Shuaib M. Abdullah, Shirling X. Tsai, Natasha S. Becker, Justin Chin-Bong Choi, Louisa Chiu, Salvatore T. Scali, Neal R. Barshes, Samir Sayed Hassan Awad, Mohammed Moursi, Matthew C. Koopmann, Mitchell B. Sally, Daniel Ihnat, Archana Ramaswamy, Warren J. Gasper, Edith Tzeng, Mark A. Wilson, Gale L. Tang, Grant D. Huang, Kousick Biswas, TOP Trial Investigators, Ellen J. Dematt, Lebrec Didier, Joe Tadalan, Robert J. Yawn, D. Briones, Brittany Coker, D. Hamm, Kamal Itani, Søren Møller Bentzen, Jason Gold, Jennifer Gassman, Brack G. Jr Hattler, Peter G. Henke, Nader Zamani, Jeffrey J. Nienaber, Mark H. Kadowaki, John Li, Khalid Bashir, Bradley R. Zagol, Whitney Sprinkle, Mary Elizabeth Sigmon, Valerie Allen, Linda Hall, Mariel Rivero, M. M. M. Silva, Ann Galla, Lorraine Howard, Lori Grove, Angela Clark, Beth E Cooke, Jessie M. Jean-Claude, Katherine J. Kelly, Gilles C. J. Pinault, Jonathan L. Kwong, Ravi N. Ambani, Nadine Elizabeth White, Tai-Lyn Wilkerson, Bala Ramanan, Thai H. Pham, Marcia Keller-Ray, Jennifer B. McClure, Nichole Pore-Brown, Sarah Balogun, Scott A. Berceli, Sarah M. Barbey, Anne Irwin, Christine Ferguson, Emilie Schmidt, Joanne Angle, Jesseca Antonie, Matthew Shunick, Qiongyao Hu, Jonathan D. Braun, Tony Lu, Natasha Z. Hansraj, Houssam K. Younes, Lea Judan, Priscilla Bigner, Amita Pathak, Ezinne Onuoha, Ahmad A. Al Hammad, Emily Broussard, Sarah Perusich, Alison A. Acott, Sandi Brock, Lisa Adams, Anthony M. T. Chau, Brian E. Smith, Aliya Asghar, M. Novin, Tasadduq Karim, Yuclemen Loya-Cano, Karyn Isip, Adaze Oheri, May Thein, Grace J. Yoo, Richiko Kime, Christian Bianchi, Theodore H. Teruya, Ronak Raval, M.R. Eby, Stephanie J. Maroney, Vicki Bishop, Angie Garcia, Cecilia Keegan, Maria Alma Rodriguez, Derrick Green, Paul M. Orecchia, Lisa Smith, Sydney Conley, Debra Johnson, Debra Hill, Marti Donaire, Hlee Yang, Derek M. Klarin, Jordan R. Stern, Mary E. Turner, Ashley H. Langston, Theresa Peters, Michelle Rojo, Karen Bratcher, Visala S. Muluk, Brian Scott Zuckerbraun, Madeline Mutinelli, Kelly E. Garbelotti, Susan Irene Barr, Eve Kellar, Karen Gilbert, Samantha A Bonant, Thomas Syphan, Patricia M. McLendon, Molly Daley, Justin Mazur, Amir F. Azarbal, Margaret K. M. Ellis, Robert B. McLafferty, J. H. Stowers, Enjae Jung, Cynthia A. Britton, Laura Onstad, Carrie Gross, Joy Usih, Ladan Yazdidoust, Jennifer Dunaj, Sandy Joos, Alexandra Bennett, Allina Cannady, Tawni Kenworthy-Heinige, Lygia Stewart, James Christopher Iannuzzi, David Cheng, Eric Sung, Eric J. T. Smith, Deborah Marquardt, Sohilkumar Naria, Kevin T. Kim, Teresita Cornell, Sharon McRae, Juliana Bondzie, James Brooks, Richard Sontchi, Rebecca Reinhard, Adam Zoble, Ronald Della Valle · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.20841 · 被引用次数：13 · 研究领域：Blood transfusion and management、Trauma, Hemostasis, Coagulopathy, Resuscitation、Cardiac, Anesthesia and Surgical Outcomes

Importance: Postoperative red blood cell transfusion guidelines recommend transfusion for hemoglobin levels less than 7 g/dL. However, the safety of this strategy in patients at high risk of cardiac events undergoing major operations remains unclear. Objective: To evaluate the risk of death or major ischemic events within 90 days after a liberal transfusion strategy compared with a restrictive transfusion strategy in patients at high risk of cardiac events who had undergone major vascular or general surgery operations and developed postoperative anemia. Design, Setting, and Participants: This parallel, single-blind, randomized clinical superiority trial included 1428 veterans (≥18 y) at high cardiac risk undergoing major vascular or general surgery operations. Participants were enrolled from February 2018 to March 2023 across 16 Veterans Affairs Medical Centers in the US. Interventions: Seven hundred fourteen participants with postoperative hemoglobin less than 10 g/dL were randomized to a liberal strategy (transfusion trigger at hemoglobin level <10 g/dL) and 714 to a restrictive strategy (transfusion trigger at hemoglobin <7 g/dL). Main Outcomes and Measures: The primary end point was a composite of all-cause death, myocardial infarction, coronary revascularization, acute kidney failure, or ischemic stroke within 90 days after randomization. Secondary end points included a composite of cardiac complications other than myocardial infarction (arrhythmias, heart failure, and n...