New summary: TRICOP, Liberal Versus Restrictive Transfusion Strategy in Critically Ill Oncological Patients: The Transfusion Requirements in Critically Ill Oncologic Patients Randomized Controlled Trial

Clinical Question

  • In cancer patients with septic shock does a restrictive vs. a liberal transfusion threshold reduce 28 day mortality?

Background

  • A number of papers have investigated what transfusion threshold we should use in critically ill patients. The TRICC study included critically ill patients with acute anaemia, and the TRISS study included patients with septic shock. Both studies reported that a restrictive strategy was safe and reduced blood transfusions. Where as the TRISOP study reported that the composite outcome of mortality and major complications was reduced with a liberal threshold in surgical oncology patients. There is the additional concern of the association of blood transfusion with cancer progression. This study was therefore performed to try and determine what transfusion threshold we should use in oncology patients with septic shock.

The Bottom Line

  • This single centre randomised controlled trial reported that in oncological patients with septic shock a restrictive vs. liberal transfusion threshold resulted in no significant difference in 28 day mortality.
  • The study reported that one of their secondary outcomes, 90 day mortality, was significantly reduced at 90 days. I would be cautious about putting too much emphasis on this result as the fragility index was 0; there were no differences in 28 and 60 day mortality as well as a number of other secondary outcomes, and with there being only 1 unit difference in median units of RBC transfused between the two treatment groups, I would be surprised if this caused a 11% difference in mortality. Larger studies would be needed to confirm or refute this finding.

Read the full summary

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