Transfusion Threshold of Hemoglobin 80 g/L Is Comparable to 100 g/L in Terms of Bleeding in Cardiac Surgery: A Prospective Randomized Study

Abstract

Anemia is common after cardiac surgery and, according to some suggestive evidence, may be associated with increased bleeding, other morbidity, and mortality. However, transfusion of red blood cells (RBC) may cause adverse effects and increase cost. The authors hypothesized that the restrictive hemoglobin threshold (Hb of 80 g/L) may aggravate bleeding more than the higher Hb threshold (Hb 100 g/L). Prospective randomized trial. University Hospital of Helsinki, Finland. Eighty patients with written informed consent, scheduled for elective open-heart surgery were randomized in 2 groups. Two study groups had RBC transfusion threshold of either Hb 80 g/L or 100 g/L. These triggers were followed for a 24-hour period postoperatively. A medical follow-up was carried out for 7 days after surgery. Rotational thromboelastometry (ROTEM) and conventional laboratory tests were performed to evaluate coagulation. There was no significant difference in bleeding or ROTEM parameters between the groups. Complication rate and Hb concentration after 7-day follow-up were not different between the groups, but Group 100 g/L had received twice the amount of RBC transfusions. Hb threshold of 80 g/L for RBC transfusion in cardiac surgery is comparable to 100 g/L in terms of bleeding and possibly short-term complications.