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Blood Transfusion 

“Based on the results of this subgroup analysis we suggest that hemodymanically stable, critically ill patients with cardiovascular disease may receive transfusions safely when the hemoglobin concentrations fall below 70 g/l and be maintained at hemoglobin concentrations between 70 and 80 g/l”
Hebert el al Critical Care Med 2001

The TRICC(36) trial is presently the best evidence to relate to perioperative transfusion practice. This trial documents liberal to restrictive transfusion practices in critically ill patients, 35% of whom were post-operative patients. The results of this trial showed that a restrictive use of blood products, with a transfusion trigger of 70 g/l, is associated with a reduced risk of in-hospital death, myocardial infarction, congestive heart failure and possibly ARDS. The investigators subsequently published a subgroup analysis of the patients with prior coronary disease(37). The patients in the restrictive group with coronary disease had a mortality rate of 26% while those in the liberal group had 20% mortality. In essence, in patients with coronary artery disease, the best result was seen in those who were treated with a liberal transfusion strategy. Therefore, we suggest a higher transfusion trigger in this patient population with a target hemoglobin of 100g/l. Certainly more investigation is needed in this area.

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