Photo Credit: Mohammed Haneefa Nizamudeen

The following is a summary of “Comparison of liberal versus restrictive transfusion strategies after hip surgery in patients with coronary artery disease: a post hoc analysis of the FOCUS trial,” published in the September 2024 issue of Cardiology by Zhang et al.

Researchers conducted a retrospective study to compare restrictive and liberal transfusion strategies in patients with coronary artery disease (CAD) undergoing hip surgery and provide recommendations for optimal transfusion practices.

They analyzed data from 805 patients with CAD who underwent hip surgery in the FOCUS trial. Participants were divided into 2 groups: those with restricted transfusion (hemoglobin level of 8 g/dL) and liberal transfusion (hemoglobin level of 10 g/dL). The primary outcome was a composite endpoint of in-hospital death, myocardial infarction, unstable angina, and acute heart failure. Secondary endpoints included other in-hospital AEs and outcomes at 30 and 60 days post-surgery, with analyses conducted using the intention-to-treat principle.

The results showed that the baseline characteristics of both groups were largely comparable, except for the proportion of patients with congestive heart failure. The median number of transfused units in the liberal transfusion group was 2, while the restricted transfusion group had a median transfusion volume of 0 units. No statistically significant difference was observed in the primary outcome between the 2 groups (9.2% vs. 9.4%, P=0.91). Notably, the incidence of in-hospital myocardial infarction events was lower in the liberal transfusion group (3.2%) compared to the restricted transfusion group (6.2%) (OR = 0.51, P=0.048). No significant differences between the groups were found for the remaining in-hospital endpoint events, excluding myocardial infarction. No significant differences between the groups in the 30-day and 60-day endpoints of death and inability to walk independently, with ORs (95% CI) of 1.00 (0.75–1.31) and 1.06 (0.80–1.41), respectively. The study found no interaction between transfusion strategies and factors like age, sex, or multiple comorbidities at the 60-day follow-up.

They found no significant difference in outcomes between liberal and restrictive transfusion strategies in patients with CAD undergoing hip surgery. Still, they observed a trend towards reduced myocardial infarction events with liberal transfusion.

Source: bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-024-04151-z