{"id":"f311e76a02ef","type":"article","url":"https://hartvaat.nl/2018/09/27/6-maandsuitkomsten-van-restrictieve-versus-liberale-transfusie-bij-hartchirurgie/","title":"6-maandsuitkomsten van restrictieve versus liberale transfusie bij hartchirurgie: NEJM TRICS III","title_en":"Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1808561","source_url":"https://doi.org/10.1056/NEJMoa1808561","authors":["C David Mazer","Richard P Whitlock","Dean A Fergusson","Emilie Belley-Cote","Katherine Connolly","Boris Khanykin","Alexander J Gregory","Étienne de Médicis","François M Carrier","Shay McGuinness","Paul J Young","Kelly Byrne","Juan C Villar","Alistair Royse","Hilary P Grocott","Manfred D Seeberger","Chirag Mehta","François Lellouche","Gregory M T Hare","Thomas W Painter","Stephen Fremes","Summer Syed","Sean M Bagshaw","Nian-Chih Hwang","Colin Royse","Judith Hall","David Dai","Nikhil Mistry","Kevin Thorpe","Subodh Verma","Peter Jüni","Nadine Shehata"],"significance":7,"published":"2018-09-27","source_date":"2018-09-27","image":"","kennis":[],"congress":"","summary_en":"The 6-month TRICS III follow-up confirmed that a restrictive transfusion strategy remains noninferior to liberal transfusion in patients undergoing cardiac surgery, supporting conservative transfusion thresholds beyond the immediate perioperative period.","created":"2026-07-03T10:27:29Z","updated":"2026-07-03T13:26:44Z","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 6-maandsresultaten die bevestigen dat restrictief transfusiebeleid niet inferieur is bij hartchirurgie.","abstract_original":"BACKGROUND: We reported previously that, in patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive transfusion strategy 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 by hospital discharge or 28 days after surgery, whichever came first. We now report the clinical outcomes at 6 months after surgery. METHODS: We randomly assigned 5243 adults undergoing cardiac surgery to a restrictive red-cell transfusion strategy (transfusion if the hemoglobin concentration was <7.5 g per deciliter intraoperatively or postoperatively) or a liberal red-cell transfusion strategy (transfusion if the hemoglobin concentration was <9.5 g per deciliter intraoperatively or postoperatively when the patient was in the intensive care unit [ICU] or was <8.5 g per deciliter when the patient was in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis occurring within 6 months after the initial surgery. An expanded secondary composite outcome included all the components of the primary outcome as well as emergency department visit, hospital readmission, or coronary revascularization occurring within 6 months after the index surgery. The secondary outcomes included the individual components of the two composite outcomes. RESULTS: At 6 months after surgery, the primary composite outcome had occurred in 402 of 2317 patients (17.4%) in the restrictive-threshold group and in 402 of 2347 patients (17.1%) in the liberal-threshold group (absolute risk difference before rounding, 0.22 percentage points; 95% confidence interval [CI], -1.95 to 2.39; odds ratio, 1.02; 95% CI, 0.87 to 1.18; P=0.006 for noninferiority). Mortality was 6.2% in the restrictive-threshold group and 6.4% in the liberal-threshold group (odds ratio, 0.95; 95% CI, 0.75 to 1.21). There were no significant between-group differences in the secondary outcomes. CONCLUSIONS: In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy for 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 at 6 months after surgery. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .)."}