Evidence map›Paper›PMID 27026510›Full record

SynthesisBMJ (Clinical research ed.)2016

Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis.

Annemarie B Docherty, Rob O'Donnell, Susan Brunskill, Marialena Trivella, Carolyn Doree, Lars Holst, Martyn Parker, Merete Gregersen, Juliano Pinheiro de Almeida, Timothy S Walsh and 1 more

Open access · bronzeAbstract readComparative StudyMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ (Clinical research ed.), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 82 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
82citing papers in PubMed, 15 pooled it
18.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

82 citing papers in PubMed, 15 syntheses or guidelines pooled it, 233 citations in OpenAlex.

  1. Pooled it
  2. Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Guideline
  6. Guideline
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Pooled it
  13. Arquivos brasileiros de cardiologia · 2017
    Guideline
  14. Pooled it
  15. Guideline
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

22 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 10 institutions in 3 countries.

Annemarie B DochertyCentre for Inflammation Research, University of Edinburgh, Edinburgh, UK Critical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK annemarie.docherty@ed.ac.uk.
Rob O'DonnellCritical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK.
Susan BrunskillSystematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Marialena TrivellaSystematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK.
Carolyn DoreeCentre for Statistics in Medicine, University of Oxford, Oxford, UK.
Lars HolstDepartment of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Martyn ParkerDepartment of Orthopaedics, Peterborough and Stamford Hospitals NHS Trust, Peterborough, UK.
Merete GregersenDepartment of Geriatrics, Aarhus University, Aarhus, Denmark.
Juliano Pinheiro de AlmeidaSurgical Intensive Care Unit and Department of Anesthesiology, Cancer Institute, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Timothy S WalshCentre for Inflammation Research, University of Edinburgh, Edinburgh, UK Critical Care Department, Royal Infirmary Edinburgh, Edinburgh, UK.
Simon J StanworthSystematic Review Initiative, NHS Blood and Transplant, John Radcliffe Hospital, Oxford, UK Department of Haematology, NHS Blood and Transplant/Oxford University Hospitals NHS Trust, Oxford, UK.
Edinburgh Royal Infirmary · GBAarhus University · DKCopenhagen University Hospital · DKHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo · BRJohn Radcliffe Hospital · GBNHS Blood and Transplant · GBOxford University Hospitals NHS Trust · GBPeterborough and Stamford Hospitals NHS Foundation Trust · GBUniversity of Edinburgh · GBUniversity of Oxford · GB

Funding

Cancer Research UK 16895
6 · The paper itself

Abstract

objectiveTo compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery.

designSystematic review and meta-analysis. DATA SOURCES: Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. TRIAL SELECTION: Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. DATA EXTRACTION AND SYNTHESIS: Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios.

main outcome measures30 day mortality, and cardiovascular events.

results41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I(2)=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I(2)=0%).

conclusionsThe results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (>80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease. REGISTRATION: PROSPERO CRD42014014251.

Indexed as

Acute Coronary SyndromeAdultBlood TransfusionCardiovascular DiseasesHumansPostoperative ComplicationsRandomized Controlled Trials as TopicSurgical Procedures, OperativeTreatment Outcome

Identifiers

PMID27026510
PMCPMC4817242
OpenAlexW2335055660

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.