{"id":"bb11ae72cb17","type":"article","url":"https://hartvaat.nl/2017/11/30/restrictieve-versus-liberale-bloedtransfusie-bij-hartchirurgie-nejm-trics-iii/","title":"Restrictieve versus liberale bloedtransfusie bij hartchirurgie: NEJM TRICS III","title_en":"Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1711818","source_url":"https://doi.org/10.1056/NEJMoa1711818","authors":["C David Mazer","Richard P Whitlock","Dean A Fergusson","Judith Hall","Emilie Belley-Cote","Katherine Connolly","Boris Khanykin","Alexander J Gregory","Étienne de Médicis","Shay McGuinness","Alistair Royse","François M Carrier","Paul J Young","Juan C Villar","Hilary P Grocott","Manfred D Seeberger","Stephen Fremes","François Lellouche","Summer Syed","Kelly Byrne","Sean M Bagshaw","Nian C Hwang","Chirag Mehta","Thomas W Painter","Colin Royse","Subodh Verma","Gregory M T Hare","Ashley Cohen","Kevin E Thorpe","Peter Jüni","Nadine Shehata"],"significance":9,"published":"2017-11-30","source_date":"2017-11-30","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The TRICS III trial demonstrated that a restrictive red-cell transfusion strategy (hemoglobin threshold <7.5 g/dL) was noninferior to a liberal strategy (<9.5 g/dL) for the composite of death, MI, stroke, or renal failure in patients undergoing cardiac surgery. The findings support restrictive transfusion thresholds in cardiac surgical patients.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM TRICS III-trial die restrictief versus liberaal transfusiebeleid vergeleek bij hartchirurgiepatiënten. Definitieve trial voor transfusiedrempels in de cardiale setting.","abstract_original":"BACKGROUND: The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. METHODS: In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, whichever came first. Secondary outcomes included red-cell transfusion and other clinical outcomes. RESULTS: The primary outcome occurred in 11.4% of the patients in the restrictive-threshold group, as compared with 12.5% of those in the liberal-threshold group (absolute risk difference, -1.11 percentage points; 95% confidence interval [CI], -2.93 to 0.72; odds ratio, 0.90; 95% CI, 0.76 to 1.07; P<0.001 for noninferiority). Mortality was 3.0% in the restrictive-threshold group and 3.6% in the liberal-threshold group (odds ratio, 0.85; 95% CI, 0.62 to 1.16). Red-cell transfusion occurred in 52.3% of the patients in the restrictive-threshold group, as compared with 72.6% of those in the liberal-threshold group (odds ratio, 0.41; 95% CI, 0.37 to 0.47). There were no significant between-group differences with regard to the other secondary outcomes. CONCLUSIONS: In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .)."}