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Doctoral Thesis
DOI
Document
Author
Full name
Rosana Ely Nakamura
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2019
Supervisor
Committee
Hajjar, Ludhmila Abrahão (President)
Almeida, Juliano Pinheiro de
Bergamin, Fabricio Sanchez
Lopes, Antonio Augusto Barbosa
Title in Portuguese
Estratégia liberal vs. restritiva de transfusão de hemácias em idosos: análise de estudos clínicos randomizados
Keywords in Portuguese
Anemia
Complicações
Ensaios clínicos
Idoso
Mortalidade
Transfusão de eritrócitos
Abstract in Portuguese
Objetivo: Comparar a evolução clínica de pacientes críticos idosos (>= 60 anos) com pacientes mais jovens (< 60 anos) após a implementação de uma estratégia liberal ou restritiva de transfusão de hemácias. Métodos: Trata-se de uma análise dos seguintes ensaios clínicos randomizados: Transfusion Requirements After Cardiac Surgery (TRACS), Transfusion Requirements in Surgical Oncologic Patients (TRISOP) e Transfusion Requirements In Critically ill Oncologic Patients (TRICOP). Nós estratificamos os pacientes em idade abaixo de 60 anos ou maior ou igual a 60 anos que foram randomizados para uma estratégia liberal ou restritiva de transfusão de hemácias. O desfecho composto foi um combinado de mortalidade em 30 dias e complicações graves. Resultados: Dos 1000 pacientes incluídos, 567 (57%) apresentavam 60 anos ou mais e 433 (43%) apresentavam menos de 60 anos e foram incluídos no estudo. O desfecho primário nos pacientes mais jovens (< 60 anos) ocorreu em 57% dos pacientes do grupo liberal e em 48% dos pacientes do grupo restritivo (p=0,060). O desfecho primário nos pacientes idosos foi alcançado em 63,3% dos pacientes no grupo liberal e em 69,4% dos pacientes no grupo restritivo (p=0,123). Entretanto, nos pacientes mais idosos, o choque cardiogênico foi mais frequente nos pacientes no grupo submetido a estratégia restritiva (14,8% vs 6%, p=0,001). Conclusões: Embora não tenha sido demonstrada nenhuma diferença no desfecho primário entre os grupos, a estratégia restritiva de transfusão foi associada a aumento da ocorrência de choque cardiogênico nos pacientes idosos críticos quando comparada a estratégia liberal. O risco cardiovascular da anemia pode ser mais deletério do que o risco da transfusão de sangue em pacientes idosos
Title in English
Liberal vs. restrictive strategy of red blood cells transfusion in elderly: analysis of randomized
Keywords in English
Anemia
Clinical study
Complications
Elderly
Erythrocyte transfusion
Mortality
Abstract in English
Objective: The aim of this study was to compare outcomes in critically ill patients who are aged 60 years or more or less than 60 years after implementation of a restrictive or a liberal transfusion strategy. Methods: This is an analysis of the Transfusion Requirements After Cardiac Surgery (TRACS) randomized clinical trial of the Transfusion Requirements in Surgical Oncologic Patients (TRISOP) randomized clinical trial and of the Transfusion Requirements In Critically ill Oncologic Patients (TRICOP) randomized clinical trial. In this analysis, we separated patients into those aged 60 years or more (elderly) and those aged less than 60 years randomized to a restrictive or a liberal strategy of red blood cell transfusion. The primary outcome was a composite defined as a combination of 30-day all-cause mortality and severe morbidity. Results: Of the 1000 patients included in the studies, 567 (57%) were aged 60 years or more and 433 (43%) were aged less than 60 years and were included in this study. The primary outcome in younger patients ( < 60 years-old) occurred in 56.9% of patients in the liberal strategy group and in 47.9% of patients in the restrictive strategy group (p=0.060). The primary outcome in elderly patients (>= 60 years-old) occurred in 63.3% of patients in the liberal strategy group and in 69.4% of patients in the restrictive strategy group (p=0.123). However, in the older patients, cardiogenic shock was more frequent in patients in the restrictive transfusion group (14.8% vs 6%, p=0.001). Conclusions: Although there was no difference between groups regarding the primary outcome, a restrictive transfusion strategy was associated with an increased rate of cardiogenic shock in elderly critical patients compared with a more liberal strategy. Cardiovascular risk of anemia may be more harmful than the risk of blood transfusion in older patients
 
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RosanaElyNakamura.pdf (6.15 Mbytes)
Publishing Date
2019-08-08
 
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