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April 20, 2018Journal of the American Geriatrics Society

Retrospective Evaluation of a Restrictive Transfusion Strategy in Older Adults with Hip Fracture

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Key result

A restrictive transfusion strategy was associated with fewer acute cardiovascular complications than a liberal strategy in older adults with hip fracture (OR 0.45; 95% CI 0.31-0.67; P<.001).

Why the study?

Does a restrictive transfusion strategy reduce in-hospital acute cardiovascular complications in older adults with hip fracture?

Population

667 individuals aged 70 and older admitted to the emergency department for hip fracture and hospitalized in…

Comparison

Restrictive transfusion strategy vs Liberal transfusion strategy

Design

Cohort

Follow-up

Up to 6 months

Authors

LZLorène ZerahLDLucile DourtheJCJudith Cohen‐Bittan

Discussion

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Overview

Restrictive transfusion was associated with fewer in-hospital cardiovascular complications in older hip fracture patients; leaves open need for prospective trials before practice change.

Study Design

Type

Observational (n=667)

Multicenter

No

Structured PICO

Does a restrictive transfusion strategy reduce in-hospital acute cardiovascular complications in older adults with hip fracture?

P
Population
667 adults aged 70 and older hospitalized for hip fracture, evaluated retrospectively for cardiovascular complications under restrictive versus liberal transfusion strategies.
E
Exposure
Restrictive transfusion strategy (hemoglobin level threshold ≥8 g/dL or symptoms)
C
Comparator
Liberal transfusion strategy (hemoglobin level threshold ≥10 g/dL)
O
Outcome
In-hospital acute cardiovascular complications (composite of heart failure, myocardial infarction, atrial fibrillation or stroke)composite

Main Result

Odds Ratio: 0.45 (95% CI 0.31–0.67)

p-value: p=<.001

A restrictive transfusion strategy in older adults with hip fracture is associated with a significant reduction in acute cardiovascular complications compared to a liberal strategy.

Limitations

  • Retrospective design requiring prospective confirmation
  • Retrospective design

Cite This Study

Zerah et al. (2018) conducted an observational in Hip fracture (n=667). Restrictive transfusion strategy vs. Liberal transfusion strategy was evaluated on in-hospital acute cardiovascular complications (heart failure, myocardial infarction, atrial fibrillation or stroke) (OR 0.45, 95% CI 0.31-0.67, p=<.001). A restrictive transfusion strategy was associated with fewer acute cardiovascular complications than a liberal strategy in older adults with hip fracture (OR 0.45; 95% CI 0.31-0.67; P<.001).

synapsesocial.com/papers/6a9bf25fbce4c781fb6bf4a8https://doi.org/10.1111/jgs.15371
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery2017 · 780 citations
  2. 2Isolated cardiac troponin rise does not modify the prognosis in elderly patients with hip fracture2017 · 28 citations
  3. 3Perioperative Management of Elderly Patients with Hip Fracture2014 · 151 citations
  4. 42016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS2016 · 6,496 citations
  5. 5An Updated Definition of Stroke for the 21st Century2013 · 3,592 citations