FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1576012015> ?p ?o ?g. }

• W1576012015 endingPage "2594" @default.
• W1576012015 startingPage "2593" @default.
• W1576012015 abstract "The pendulum has swung toward using lower transfusion thresholds. The probable reasons for this change in practice toward using lower transfusion thresholds include accumulating evidence that use of less blood is safe in most patients,1 recommendations from practice guidelines,2, 3 and growing influence of blood management programs.4-8 There are now more than 7000 patients that have been enrolled in trials that compared restrictive transfusion threshold between 7 and 8 g/dL and liberal transfusion threshold between 9 and 10 g/dL.1, 9 One trial permitted symptoms to trigger transfusion.10 Overall, these trials suggest that a restrictive transfusion approach is as safe as, and in one trial superior to, liberal transfusion.11 There is a trend toward lower mortality at 30 days1 and lower risk of bacterial infection in patients assigned to the restrictive transfusion groups.12 The one exception is in patients with acute myocardial infarction. Small trials raise the possibility that mortality is lower using a liberal transfusion threshold than restrictive transfusion threshold.13, 14 Further studies are needed in this important group of patients.15 The most influential trials used a restrictive transfusion threshold between 7 and 8 g/dL.10, 11, 16 Since patients were not harmed by these lower thresholds, it is reasonable to hypothesize that patients might tolerate an even lower transfusion threshold and further avoid exposure to transfusions. The results from the article by Shander and colleagues17 in this issue of TRANSFUSION suggest that an even lower transfusion threshold might be possible. This single-center study evaluated the mortality and morbidity in 293 patients undergoing surgery with postoperative hemoglobin (Hb) level less than 8 g/dL who declined blood transfusion. The investigators closely replicated the methods used in our prior analysis of 300 similar patients published in 2002.18 Mortality was assessed at 30 days postsurgery. The composite outcome of morbidity included arrhythmia, infections, myocardial infarction, and congestive heart failure. The overall mortality was 8.2% (95% confidence interval [CI], 5%-11.3%) and the adjusted odds of death for each gram decrement in Hb concentration was 1.82 (95% CI, 1.27-2.59). The adjusted odds ratio (OR) for composite morbidity outcome was similar. Table 1 examines the unadjusted rate of death by 1 g/dL decrements of the nadir postoperative Hb level in the two series of bloodless surgery patients. In contrast to the authors' interpretation, we conclude that the risk of death is very similar between the two series of patients even though they were hospitalized decades apart. The rate of death was very low in patients with postoperative Hb levels between 7.0 and 7.9 g/dL. Importantly, mortality appears to increase gradually but then accelerates when the Hb level is below 5 g/dL. Furthermore, the adjusted OR of death between the two studies for each gram decrease of Hb have overlapping CIs—1.82 (95% CI, 1.27-2.59)17 in the present study versus 2.5 (95% CI, 1.9-3.2) in our 2002 study.18 These results suggest that it would be reasonable to conduct a clinical trial comparing patients randomly allocated to 5 or 6 g/dL threshold versus 7 to 8 g/dL threshold. It seems possible that patients would tolerate these lower thresholds, although we could also find that transfusion reduces mortality and/or morbidity at these lower thresholds. Such a trial might best be performed in locations where clinicians frequently use lower thresholds either because of less availability of blood and/or because the risk of blood transfusion is higher, a common situation in the developing world. The study by Shander and colleagues provides important insights to the care of bloodless patients and the data needed to inform patients about their risks associated with declining transfusion. These data also provide critical information needed to identify at what Hb level the risk of death increases and provide rational targets to use in trials. Perhaps we can use an even lower transfusion trigger. It is time to perform that trial. The authors have disclosed no conflicts of interest." @default.
• W1576012015 created "2016-06-24" @default.
• W1576012015 creator A5017708297 @default.
• W1576012015 creator A5063558900 @default.
• W1576012015 date "2014-10-01" @default.
• W1576012015 modified "2023-09-26" @default.
• W1576012015 title "Red blood cell transfusion thresholds: can we go even lower?" @default.
• W1576012015 cites W127034668 @default.
• W1576012015 cites W1485206462 @default.
• W1576012015 cites W1604436547 @default.
• W1576012015 cites W1968110103 @default.
• W1576012015 cites W1972669243 @default.
• W1576012015 cites W1998564207 @default.
• W1576012015 cites W2068785908 @default.
• W1576012015 cites W2094746327 @default.
• W1576012015 cites W2106407512 @default.
• W1576012015 cites W2107968624 @default.
• W1576012015 cites W2111334799 @default.
• W1576012015 cites W2136098489 @default.
• W1576012015 cites W2147368252 @default.
• W1576012015 cites W2150634117 @default.
• W1576012015 cites W2163332984 @default.
• W1576012015 cites W2166775199 @default.
• W1576012015 cites W4253234035 @default.
• W1576012015 doi "https://doi.org/10.1111/trf.12812" @default.
• W1576012015 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/25308048" @default.
• W1576012015 hasPublicationYear "2014" @default.
• W1576012015 type Work @default.
• W1576012015 sameAs 1576012015 @default.
• W1576012015 citedByCount "12" @default.
• W1576012015 countsByYear W15760120152015 @default.
• W1576012015 countsByYear W15760120152016 @default.
• W1576012015 countsByYear W15760120152018 @default.
• W1576012015 countsByYear W15760120152019 @default.
• W1576012015 countsByYear W15760120152020 @default.
• W1576012015 crossrefType "journal-article" @default.
• W1576012015 hasAuthorship W1576012015A5017708297 @default.
• W1576012015 hasAuthorship W1576012015A5063558900 @default.
• W1576012015 hasConcept C141071460 @default.
• W1576012015 hasConcept C177713679 @default.
• W1576012015 hasConcept C2780014101 @default.
• W1576012015 hasConcept C2911063046 @default.
• W1576012015 hasConcept C71924100 @default.
• W1576012015 hasConceptScore W1576012015C141071460 @default.
• W1576012015 hasConceptScore W1576012015C177713679 @default.
• W1576012015 hasConceptScore W1576012015C2780014101 @default.
• W1576012015 hasConceptScore W1576012015C2911063046 @default.
• W1576012015 hasConceptScore W1576012015C71924100 @default.
• W1576012015 hasIssue "10pt2" @default.
• W1576012015 hasLocation W15760120151 @default.
• W1576012015 hasLocation W15760120152 @default.
• W1576012015 hasOpenAccess W1576012015 @default.
• W1576012015 hasPrimaryLocation W15760120151 @default.
• W1576012015 hasRelatedWork W107068232 @default.
• W1576012015 hasRelatedWork W2012564050 @default.
• W1576012015 hasRelatedWork W2070201435 @default.
• W1576012015 hasRelatedWork W2142126669 @default.
• W1576012015 hasRelatedWork W2332193474 @default.
• W1576012015 hasRelatedWork W2339138297 @default.
• W1576012015 hasRelatedWork W2801909546 @default.
• W1576012015 hasRelatedWork W3208072607 @default.
• W1576012015 hasRelatedWork W4317433590 @default.
• W1576012015 hasRelatedWork W190068422 @default.
• W1576012015 hasVolume "54" @default.
• W1576012015 isParatext "false" @default.
• W1576012015 isRetracted "false" @default.
• W1576012015 magId "1576012015" @default.
• W1576012015 workType "article" @default.