When to Pull the Transfusion Trigger After Ortho Trauma Surgery

Maybe not as quickly as we once did, but you decide if you want to hang on as long as they did in this RCT.

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Editor’s Note: Sometimes at CORRelations, we’ll cover an article we think is likely to cross your desk, but is one whose message we have reservations about. Here’s one. — SSL

What’s the Claim?

An RCT compared two transfusion triggers (“liberal,” which aimed to keep Hgb ≥ 7 g/dL, and “conservative,” which aimed for > 5.5 g/dL) in patients with musculoskeletal trauma and without symptoms of acute blood-loss anemia, who were between the ages of 18 and 50, and who were beyond the initial resuscitative period. Restrictive inclusion criteria limited this study to patients who were pretty fit at baseline — no serious cardiac, renal, hepatic, or pulmonary disease, among other things.

It found the risk of deep infection was greater in the liberal transfusion group (10% versus 0%; p = 0.03). There were no between-group differences in other complications or endpoints of interest, though they were seriously underpowered for the events of greatest interest, a point we’ll come back to.

How’s It Stack Up?