Clinical outcomes at 6 months were similar with a liberal and a restrictive transfusion strategy, according to data from the TRICS III trial.
In the international Transfusion Requirements in Cardiac Surgery (TRICS) III trial (NCT02042898), a restrictive red-cell transfusion strategy was shown to be noninferior to a liberal strategy for clinical outcomes within 28 days after surgery (N Engl J Med 2017; 377:2133). However, earlier studies had suggested that a restrictive strategy would confer worse longer-term outcomes, including mortality (e.g.,Ann Thorac Surg 2012; 94:460).
In TRICS III, 5243 adults undergoing cardiac surgery who had at least a moderate risk of death (EuroScore ≥6) had been randomized to one of two red-cell transfusion strategies, according to intraoperative or postoperative hemoglobin concentration:
Researchers have now examined 6-month outcomes.
At 6 months after surgery, the two groups did not differ significantly in the primary outcome — all-cause mortality, myocardial infarction, stroke, or new-onset renal failure requiring dialysis (17.4% for the restrictive strategy and 17.1% for the liberal strategy) — or prespecified secondary outcomes, including all-cause mortality (6.2% and 6.4%, respectively). The restrictive strategy was associated with a significantly lower incidence of the primary endpoint among patients age 75 or older.