Liberal Blood Transfusion for Patients with CV Disease and Postoperative Anemia?

A restrictive transfusion strategy (targeting hemoglobin >7 g/dl) is recommended for most hospitalized patients with anemia, but do surgical patients with cardiovascular (CV) disease benefit from a higher threshold (see Figure 1)? In this trial, 1400 U.S. veterans (mean age, 70; >95% male) with high CV risk who were undergoing mostly vascular surgeries were randomly assigned to either a liberal (hemoglobin >10 g/dl) or restrictive transfusion strategy. Mean hemoglobin was ≈11 g/dl preoperatively and ≈9 g/dl at randomization. Protocolized transfusion of blood to maintain hemoglobin above the assigned threshold was continued until discharge.