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Restrictive transfusion strategy after cardiac surgery.

Zeroual and colleagues report the results of a single-centre, single-blinded randomised controlled study of cardiac surgery patients comparing two strategies for transfusion of red blood cells. The control group followed a standard regime with transfusion of red blood cells if the haemoglobin level fell < 9 g/dL. In the intervention group, transfusion of red blood […]

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study.

Surgical patients may be at high risk of venous thromboembolism (VTE). SARS‐CoV‐2 infection has been shown to increase this risk. In this huge international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020, the authors included 123,791 patients from all surgical specialities in 1630 hospitals and 115 countries. The primary outcome measure […]

Viscoelastic haemostatic assay augmented protocols for major trauma haemorrhage (ITACTIC): a randomized, controlled trial.

Current approaches to trauma resuscitation focus on the timely control of bleeding and correction of trauma-induced coagulopathy using the administration of haemostatic therapy. Over the past decade, targeted and individualized strategies to identify and correct coagulopathy have been implemented. Conventional coagulation tests have been incorporated into standardized transfusion algorithms but suffer from slow turn-around times. […]

Routine venous thromboembolism prophylaxis may be inadequate in the hypercoagulable state of severe coronavirus disease 2019.

This observationnal study has included 240 consecutive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection  admitted to one of three hospitals. One-hundred nine critically ill COVID 19 patients admitted to the ICU were included in the analysis.  Venous thromboembolism was diagnosed in 31 patients (28%) 8 ± 7 days after hospital admission, including two […]

Effect of hydroxyethyl starch vs saline for volume replacement therapy on death or postoperative complications among high-risk patients undergoing major abdominal surgery: the FLASH randomized clinical trial.

There are few drugs that have gone through such a rollercoaster ride as hydroxyethyl starch (HES). While shortly after its introduction the belief still prevailed that all types of volume deficiency could be best treated with HES, this picture has changed considerably in recent years. A number of more or less well-done studies have been […]

Fibrinogen concentrate to cardiac surgery patients with ongoing bleeding does not increase the risk of thromboembolic complications or death.

In this retrospective, observational study, Waldén et al. describe the occurrence of thromboembolic events and mortality in cardiac surgery patients, depending on whether the patient had received fibrinogen supplementation. The study comprises 5,408 patients, of which 564 (10.4%) received fibrinogen during cardiac surgery. Patients receiving fibrinogen had lower preoperative levels of fibrinogen and platelet count, […]

Effects of iron isomaltoside vs ferric carboxymaltose on hypophosphatemia in iron-deficiency anemia: two randomized clinical trials.

This article describes a new physiology via the upregulation of FGF23 by ferric carboxymaltose (FCM) with subsequent development of hypophosphatemia.  It provides a degree of caution with the long-term use of this formulation of IV iron but aptly points out that clinically significant hypophosphatemia is rare.  What this should do is stimulate long-term evaluation of […]

Liberal versus restrictive red blood cell transfusion thresholds in hematopoietic cell transplantation: a randomized, open label, phase III, noninferiority trial.

This trial is a non-inferiority RCT comparing the effect of a liberal versus restrictive transfusion strategy on health-related quality of life (HRQOL) in patients undergoing haematopoietic stem cell (HCT) transplant. The study focuses on HRQOL since multiple transfusion trials have already examined and shown no difference between a liberal versus restrictive transfusion strategy on mortality […]

Postoperative anaemia might be a risk factor for postoperative delirium and prolonged hospital stay: A secondary analysis of a prospective cohort study.

This study examines the association between postoperative anaemia and postoperative delirium. Given the high prevalence of postoperative anaemia, the authors were interested in understanding whether the lower oxygen delivery associated with anaemia would result in higher rates of postoperative delirium. This study was a secondary analysis of a previously done retrospective study. The study population […]

Rivaroxaban compared with standard anticoagulants for the treatment of acute venous thromboembolism in children: a randomised, controlled, phase 3 trial.

In this multicentre, parallel-group, open-label, randomised trial, the authors compared the efficacy and safety of rivaroxaban versus standard anticoagulants in children 0-17 years with venous thromboembolism. Across 107 paediatric hospitals in 28 countries, children with documented acute venous thromboembolism (VTE) who had started heparin were assigned (2:1) to weight-adjusted rivaroxaban or standard anticoagulants (heparin or […]

Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death.

The Platelets for Neonatal Thrombocytopenia (PlaNeT-2) trial, a multicentre randomised clinical trial, found an unexpected overall benefit of a prophylactic platelet transfusion threshold of 25 x 10^9/L compared to 50 x 10^9/L for major bleeding and/or mortality within 28 days of randomization in preterm neonates (7% absolute risk reduction). To assess if there was heterogeneity of treatment effect and […]