Key result
cPOTTS reduces RBC transfusions vs conventional guidelines without increasing perioperative myocardial ischemia.
Why the study?
A simple and accurate scoring system to guide perioperative blood transfusion in patients with CAD undergoing cardiac surgery was lacking, as their transfusion triggers may differ from existing guidelines.
Does the Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) safely reduce blood transfusion requirements compared to conventional evaluation in patients with CAD undergoing cardiac surgery?
RCT (n=500)
Open-label
Computer randomization software (SAS 9.1)
Yes
Does the Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) safely reduce blood transfusion requirements compared to conventional evaluation in patients with CAD undergoing cardiac surgery?
The cPOTTS scoring system safely reduces red blood cell transfusion utilization, hospital stay, and costs without increasing mortality or ischemic events in CAD patients undergoing cardiac surgery.
Supports cPOTTS-guided transfusion in CAD cardiac surgery to lower costs and resource use; extends restrictive transfusion evidence without compromising safety.
BACKGROUND: A simple and accurate scoring system to guide perioperative blood transfusion in patients with coronary artery disease (CAD) undergoing cardiac surgery is lacking. The trigger point for blood transfusions for these patients may be different from existing transfusion guidelines. This study aimed to evaluate the safety and efficacy of a new scoring strategy for use in guiding transfusion decisions in patients with CAD. METHODS: A multicenter randomized controlled trial was conducted at three third-level grade-A hospitals from January 2015 to May 2018. Data of 254 patients in a Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) group and 246 patients in a group receiving conventional evaluation of the need for transfusion (conventional group) were analysed. The requirements for transfusion and the per capita consumption of red blood cells (RBCs) were compared between groups. RESULTS: Baseline characteristics of the two groups were comparable. Logistic regression analyses revealed no significant differences between the two groups in primary outcomes (1-year mortality and perioperative ischemic cardiac events), secondary outcomes (shock, infections, and renal impairment), ICU admission, and ICU stay duration. However, patients in the cPOTTS group had significantly shorter hospital stays, lower hospital costs, lower utilization rate and lower per capita consumption of transfused RBCs than controls. Stratified analyses revealed no significant differences between groups in associations between baseline characteristics and perioperative ischemic cardiac events, except for hemofiltration or dialysis and NYHA class in I. CONCLUSIONS: This novel scoring system offered a practical and straightforward guideline of perioperative blood transfusion in patients with CAD. Trial registration chiCTR1800016561(2017/7/19).
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Ma et al. (2021) conducted an RCT in Coronary artery disease (n=500). Cardiac Peri-Operative Transfusion Trigger Score (cPOTTS) vs. Conventional transfusion guidelines was evaluated on Perioperative myocardial ischemia (component of primary ischemic cardiac events) (OR 0.61, 95% CI 0.34-1.11, p=0.10). The cPOTTS scoring system significantly reduced the utilization rate of red blood cell transfusions compared to conventional guidelines, without significantly increasing the risk of primary outcomes such as perioperative myocardial ischemia (OR 0.61).
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