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A restrictive versus liberal transfusion strategy to prevent myocardial injury in patients undergoing surgery for fractured neck of femur: a feasibility randomised trial (RESULT-NOF)

Gillies, M.A.; Ghaffar, S.; Moppett, I.K.; Docherty, A.B.; Clarke, S.; Rea, N.; Stephen, J.; Keerie, C.; Ray, D.C.; White, T.O.; McLullich, A.M.J.; Mills, N.L.; Rowley, M.R.; Murthy, K.; Pearse, R.M.; Stanworth, S.J.; Walsh, T.S.

A restrictive versus liberal transfusion strategy to prevent myocardial injury in patients undergoing surgery for fractured neck of femur: a feasibility randomised trial (RESULT-NOF) Thumbnail


Authors

M.A. Gillies

S. Ghaffar

IAIN MOPPETT iain.moppett@nottingham.ac.uk
Professor of Anaesthesia and Perioperative Medicine

A.B. Docherty

S. Clarke

N. Rea

J. Stephen

C. Keerie

D.C. Ray

T.O. White

A.M.J. McLullich

N.L. Mills

M.R. Rowley

K. Murthy

R.M. Pearse

S.J. Stanworth

T.S. Walsh



Abstract

Background
The optimum transfusion strategy in patients with fractured neck of femur is uncertain, particularly if there is coexisting cardiovascular disease.

Methods
We conducted a prospective, single-centre, randomised feasibility trial of two transfusion strategies. We randomly assigned patients undergoing surgery for fractured neck of femur to a restrictive (haemoglobin, 70–90 g L −1) or liberal (haemoglobin, 90–110 g L −1) transfusion strategy throughout their hospitalisation. Feasibility outcomes included: enrolment rate, protocol compliance, difference in haemoglobin, and blood exposure. The primary clinical outcome was myocardial injury using troponin estimations. Secondary outcomes included major adverse cardiac events, postoperative complications, duration of hospitalisation, mortality, and quality of life.

Results
We enrolled 200 (22%) of 907 eligible patients, and 62 (31%) showed decreased haemoglobin (to 90 g L −1 or less) and were thus exposed to the intervention. The overall protocol compliance was 81% in the liberal group and 64% in the restrictive group. Haemoglobin concentrations were similar preoperatively and at postoperative day 1 but lower in the restrictive group on day 2 (mean difference [MD], 7.0 g L −1; 95% confidence interval [CI], 1.6–12.4). Lowest haemoglobin within 30 days/before discharge was lower in the restrictive group (MD, 5.3 g L −1; 95% CI, 1.7–9.0). Overall, 58% of patients in the restrictive group received no transfusion compared with 4% in the liberal group (difference in proportion, 54.5%; 95% CI, 36.8–72.2). The proportion with the primary clinical outcome was 14/26 (54%, liberal) vs 24/34 (71%, restrictive), and the difference in proportion was –16.7% (95% CI, –41.3 to 7.8; P=0.18).

Conclusion
A clinical trial of two transfusion strategies in hip fracture with a clinically relevant cardiac outcome is feasible.

Journal Article Type Article
Acceptance Date Jun 26, 2020
Online Publication Date Jul 20, 2020
Publication Date Jan 1, 2021
Deposit Date Jun 30, 2020
Publicly Available Date Jul 21, 2021
Journal British Journal of Anaesthesia
Print ISSN 0007-0912
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 126
Issue 1
Pages 77-86
DOI https://doi.org/10.1016/j.bja.2020.06.048
Keywords Anaemia; myocardial injury; hip fracture; feasibility; randomised controlled trial
Public URL https://nottingham-repository.worktribe.com/output/4739668
Publisher URL https://bjanaesthesia.org/article/S0007-0912(20)30508-0/abstract#articleInformation

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