Blood Transfusion and 30-Day Mortality in Patients With Coronary Artery Disease and Anemia Following Noncardiac Surgery

The authors studied the relationship of outcomes after non-cardiac surgery to blood transfusion among over 7,300 patients.   Patients with significant bleeding were excluded.  Patients were stratified according to the occurence of postoperative MI and the nadir hematocrit value (20-24%, 24-27%, 27-30%).  The outcome was 30-day mortality.   In the no-transfusion group, mortality increased as nadir hematocrit decreased.  In patients with an MI, mortality was lower in the low hematocrit patients who received a transfusion.  In patients without an MI, mortality was increased for patients in the high hematocrit group who received a transfusion.  In patients with stable cardiovascular status postoperatively, a restrictive transfusion policy is appropriate.  Those who have cardiovascular instability or MI may require a different transfusion strategy.