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Liberal Transfusion Nonsuperior Post-Hip Fracture Surgery

Similar rates of death, ability to walk independently with liberal or restrictive transfusion

WEDNESDAY, Dec. 14 (HealthDay News) -- A liberal blood transfusion strategy (maintenance at a threshold of 10 g/dL hemoglobin) is not superior to a restrictive strategy (transfusion at symptoms of anemia or <8 g/dL hemoglobin) for reducing death and inability to walk independently after hip fracture surgery, according to a study published online Dec. 14 in the New England Journal of Medicine.

Jeffrey L. Carson, M.D., from the Robert Wood Johnson Medical School in New Brunswick, N.J., and colleagues investigated the effects of blood transfusion strategy on hip fracture surgery recovery in 2,016 patients (aged ≥50 years) with cardiovascular risk factors or history and hemoglobin <10 g/dL. Participants were randomly assigned to either a liberal or restrictive transfusion strategy. During a 60-day follow-up, death or an inability to walk across a room without human assistance, was the primary outcome.

The investigators found that patients in the liberal group were transfused a median of two units of red blood cells versus none in the restrictive-strategy group. The rates of primary outcome were 35.2 and 34.7 percent in liberal and restrictive groups, respectively (odds ratio in liberal group, 1.01; 95 percent confidence interval [CI], 0.84 to 1.22). The corresponding rates of in-hospital acute coronary syndrome or death for the liberal and restrictive transfusion groups were 4.3 and 5.2 percent, respectively, while the corresponding rates of death at 60-day follow-up were 7.6 and 6.6 percent, respectively. There were similar rates of other complications for the two groups.

"Liberal transfusion strategy, as compared with a restrictive strategy, did not reduce rates of death or inability to walk independently," the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, and biotechnology industries.

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