Is a liberal transfusion strategy better than a symptomatic strategy in patients with cardiovascular disease undergoing surgical hip fracture repair?

Abstract

In patients with hip fracture, anemia may result as a direct consequence of the injury or surgery. Red blood cell transfusions are commonly administered to surgical patients in response to operative hemorrhage, and to treat anemia. However, the impact of transfusions on mortality and morbidity in patients with hip fracture is still unclear. A large observational study finds no beneficial effect of transfusion on mortality regardless of the presence of preexisting cardiovascular disease [1]. Other studies suggest that anemia decreases physical performance and postoperative rehabilitation in patients with hip fracture, and red blood cell transfusions improve short-term functional outcomes [2, 3]. To date, there are few randomized clinical trials (RCT) assessing the clinical impact of different transfusion thresholds. A large study involving patients in intensive care units shows that a restrictive strategy of redcell transfusion is at least as effective as and possibly superior to a liberal transfusion strategy in critically ill patients [4]. However, there are no RCTs evaluating the safety of withholding transfusion until symptoms of anemia develop in patients with hip fracture. Furthermore, the safety of symptomatic transfusion in patients with cardiovascular disease and the impact of a lower transfusion threshold on functional recovery after surgical hip repair have not been studied. Summary