Which Transfusion Strategy for High-Risk Cardiac Surgery Patients?

In the international Transfusion Requirements in Cardiac Surgery (TRICS) III trial (NCT02042898), a restrictive red-cell transfusion strategy was shown to be noninferior to a liberal strategy for clinical outcomes within 28 days after surgery (N Engl J Med 2017; 377:2133). However, earlier studies had suggested that a restrictive strategy would confer worse longer-term outcomes, including mortality (e.g., Ann Thorac Surg 2012; 94:460).

In TRICS III, 5243 adults undergoing cardiac surgery who had at least a moderate risk of death (EuroScore ≥6) had been randomized to one of two red-cell transfusion strategies, according to intraoperative or postoperative hemoglobin concentration:

• Restrictive strategy: hemoglobin <7.5 g/dL

• Liberal strategy: hemo…