Liberal or restrictive transfusion in high-risk patients after hip surgery.
Liberal or restrictive transfusion in high-risk patients after hip surgery.
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DOI：
10.1056/nejmoa1012452
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发表时间：
2011-12-29
期刊：
影响因子：
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通讯作者：
FOCUS Investigators
中科院分区：
文献类型：
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作者：
Carson JL;Terrin ML;Noveck H;Sanders DW;Chaitman BR;Rhoads GG;Nemo G;Dragert K;Beaupre L;Hildebrand K;Macaulay W;Lewis C;Cook DR;Dobbin G;Zakriya KJ;Apple FS;Horney RA;Magaziner J;FOCUS Investigators
术后红细胞输注的血红蛋白阈值是有争议的。我们进行了一项随机试验，以确定较高的输血阈值是否会改善髋部骨折手术患者的恢复。我们招募了2016名50岁或以上的患者，他们有心血管疾病史或危险因素，并且在髋部骨折手术后血红蛋白水平低于10 g/dl。我们将患者随机分为自由输血策略（血红蛋白阈值为10 g/dl）或限制性输血策略（贫血症状或血红蛋白水平<8 g/dl）。主要结局是在60天随访中死亡或在没有人类帮助的情况下无法穿过房间。自由策略组输注红细胞的中位数为2个单位，限制策略组无输注。自由策略组的主要结局发生率为35.2%，限制策略组为34.7%（自由策略组的比值比为1.01; 95%置信区间为0.84 ~ 1.22），绝对风险差异为0.5个百分点（95%置信区间为-3.7 ~4.7）。住院急性冠脉综合征或死亡率分别为4.3%和5.2%（绝对风险差，-0.9%; 99%CI，-3.3至1.6），60天随访时的死亡率分别为7.6%和6.6%（绝对风险差，1.0%; 99%CI，-1.9至4.0）。两组其他并发症发生率相似。与限制性策略相比，自由输血策略并没有降低60天随访时死亡率或无法独立行走的发生率，也没有降低心血管高危老年患者的住院发病率。（由国家心肺血液研究所资助; FOCUS ClinicalTrials.gov编号，NCT 00071032。
The hemoglobin threshold at which postoperative red-cell transfusion is warranted is controversial. We conducted a randomized trial to determine whether a higher threshold for blood transfusion would improve recovery in patients who had undergone surgery for hip fracture. We enrolled 2016 patients who were 50 years of age or older, who had either a history of or risk factors for cardiovascular disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. We randomly assigned patients to a liberal transfusion strategy (a hemoglobin threshold of 10 g per deciliter) or a restrictive transfusion strategy (symptoms of anemia or at physician discretion for a hemoglobin level of <8 g per deciliter). The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up. A median of 2 units of red cells were transfused in the liberal-strategy group and none in the restrictive-strategy group. The rates of the primary outcome were 35.2% in the liberal-strategy group and 34.7% in the restrictive-strategy group (odds ratio in the liberal-strategy group, 1.01; 95% confidence interval [CI], 0.84 to 1.22), for an absolute risk difference of 0.5 percentage points (95% CI, −3.7 to 4.7). The rates of in-hospital acute coronary syndrome or death were 4.3% and 5.2%, respectively (absolute risk difference, −0.9%; 99% CI, −3.3 to 1.6), and rates of death on 60-day follow-up were 7.6% and 6.6%, respectively (absolute risk difference, 1.0%; 99% CI, −1.9 to 4.0). The rates of other complications were similar in the two groups. A liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently on 60-day follow-up or reduce in-hospital morbidity in elderly patients at high cardiovascular risk. (Funded by the National Heart, Lung, and Blood Institute; FOCUS ClinicalTrials.gov number, NCT00071032.)