All About Bleeding: Transfusion targets after cardiac surgery and intracranial bleeding on warfarin

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This week: The TITRE2 trial about hemoglobin transfusion strategies after cardiac surgery and the RETRACE study about intracranial bleeding in patients on warfarin.

Nathan and Amol want you to understand the following:

1. In cardiac surgery patients, a restrictive transfusion strategy was no different than liberal transfusion in terms of combined clinical outcomes of infectious and vascular events but may have been associated with increased mortality.

2. In patients on oral anticoagulants with an intracranial bleed, a retrospective study found that reversal of anticoagulation to an INR of < 1.3 within 4 hours and a systolic blood pressure of < 160 mmHg was associated with less extension of bleeding. Re-starting oral anticoagulation after intracranial bleed was associated with fewer ischemic events and no more bleeding. These results are limited by the retrospective design.

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The papers

GJ Murphy et al. Liberal or restrictive transfusion after cardiac surgery. N Engl J Med. 2015 Mar 12;372(11):997-1008. (PubMed).

JB Kuramatsu et al. Anticoagulant reversal, blood pressure levels, and anticoagulant resumption in patients with anticoagulation-related intracerebral hemorrhage. JAMA. 2015 Feb 24;313(8):824-36. (PubMed).

Good stuff

Being Mortal. Atul Gawande.

Finding Equilibrium in See-Sawing Libidos. Mark Jaffe. New York Times. 6 Mar 2015.

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