Voluminous Blood Transfusion Ineffectual in Hip Surgery

Hip-fracture patients with an increased cardiovascular (CV) risk gained no survival or functional benefits from liberal use of blood transfusions, according to a new study.

Researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ; New Brunswick, USA) conducted a randomized trial involving 2,016 patients (50 years of age or older), who had either a history of or risk factors for CV disease, and whose hemoglobin level was below 10 g per deciliter after hip-fracture surgery. The researchers randomly assigned patients to a liberal transfusion strategy, receiving a median of two units of red blood cells (RBCs), or a restrictive strategy, receiving 65% fewer units of blood, with half of the restrictive patients receiving no transfusions at all. The primary outcome was death or an inability to walk across a room without human assistance on 60-day follow-up.

The results showed that 35% of patients in the liberal-transfusion group met the primary endpoint, compared with 34.7% of patients randomized to the restrictive transfusion strategy. Additionally, 4.3% of the liberal-transfusion arm had an acute coronary syndrome or died in hospital, compared with 5.2% of patients in the restrictive-transfusion arm. The 60-day mortality was 7.6% with the liberal transfusion strategy and 6.6% with the restrictive strategy; complication rates also were similar between the two groups. The study was published ahead of print on December 14, 2011, in the New England Journal of Medicine (NEJM).

“It is reasonable to withhold transfusion in patients who have undergone surgery in the absence of symptoms of anemia or a decline in the hemoglobin level below 8 g per deciliter, even in elderly patients with underlying cardiovascular disease or risk factors,” concluded lead author Jeffrey Carson, MD, and colleagues. “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.”

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University of Medicine and Dentistry of New Jersey