CHEST Guidelines-Change-in-Clinical-Practice-Associated-With-a-Larg

Change-in-Clinical-Practice-Associated-With-a-Larg

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A study published in 2020 investigated the impact of the Transfusion Indication Threshold Reduction (TITRe2) trial on red blood cell (RBC) transfusion practices in cardiac surgery. The TITRe2 trial in 2015 highlighted increased mortality rates at restrictive transfusion thresholds after cardiac surgery, prompting a reevaluation of transfusion strategies. This retrospective study examined changes in pretransfusion hemoglobin levels in cardiac surgery across major public hospitals in Western Australia from 2009 to 2017, before and after the TITRe2 trial's publication.<br /><br />Researchers analyzed data from the Western Australia Patient Blood Management Data System, focusing on adults undergoing elective and non-elective cardiac surgery, including coronary artery bypass graft and valve procedures. The study assessed trends in hemoglobin levels pre- and post-TITRe2 publication, making comparisons with noncardiac surgery as a control group.<br /><br />The study included a total of 13,449 surgical patients and 26,765 transfusion events, recording a significant influence of the TITRe2 trial on transfusion practices. Prior to the publication, hemoglobin thresholds in cardiac surgery demonstrated a declining trend similar to noncardiac surgery. However, post-publication, cardiac surgery thresholds significantly increased, indicating a shift back to more liberal transfusion practices, whereas noncardiac surgery continued its declining trend.<br /><br />The findings suggest a clear association between the TITRe2 trial and increased pretransfusion hemoglobin levels in cardiac surgery, although researchers acknowledge other potential contributing factors. These shifts underscore the impact of large randomized controlled trials on clinical practice. The study did not track changes in non-RBC transfusions and notes the TRICS-III trial from 2017 could further influence clinical practice with its findings on transfusion thresholds.

Keywords

TITRe2 trial

cardiac surgery

red blood cell transfusion

hemoglobin levels

Western Australia

patient blood management

transfusion practices

mortality rates

TRICS-III trial

randomized controlled trials