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The optimal threshold to initiate postoperative red blood cell (RBC) transfusion therapy in older surgical patients remains controversial. In a multicenter nonblinded trial, U.S. and Canadian researchers enrolled more than 2000 older patients (mean age, 82) at high cardiovascular risk whose hemoglobin (Hb) levels were <10 g/dL after hip fracture surgery. Patients were randomized to a liberal transfusion strategy (transfusion at Hb <10 g/dL) or to a restrictive transfusion strategy (transfusion when anemia symptoms developed or at physicians' discretion for Hb <8 g/dL).
Patients in the liberal group received an average of three times more RBC transfusions than did the restrictive group. No differences were noted between the groups in the prim…