15 April 2009
Blood transfusions carried out after cardiac surgery could be
unnecessary and might cause health complications for
patients. Thanks to a £1 million grant by the National
Institute for Health Research Health Technology Assessment (NIHR
HTA) programme a new research study will investigate this
issue.
In the UK, cardiac surgery uses almost ten per cent of all donor
blood. Although the benefits of red cell blood transfusions for
managing life-threatening bleeding are clear, the majority of
decisions to transfuse after surgery are made on the basis of a
patients haemoglobin level (a measure of the ability of the blood
to transport oxygen around the body).
The level that causes a doctor to transfuse a patient varies
widely and research in non-cardiac surgical fields has shown that
lowering the level that triggers transfusion reduces complications
as well as the use of blood.
Barnaby Reeves, Professorial Research Fellow in Health Services
Research at the University of Bristol and Gavin Murphy, Walport
Consultant Senior Lecturer in Cardiac Surgery at University
Hospitals Bristol NHS Foundation Trust will lead the
study.
The new research will examine if withholding blood transfusion
until the patient reaches a lower haemoglobin trigger point will
improve the outcome for cardiac surgery patients and also reduce
hospital costs.
The study will take the form of a randomised control trial at
several hospitals across the UK. Patients identified from
both outpatient and in-patient waiting lists will be invited to
take part in the trial before surgery takes place.
Mr Murphy explained: Unnecessary blood transfusions increase
healthcare costs both directly, because blood is an increasingly
scarce and expensive resource, and indirectly, due to complications
associated with transfusion.
Transfusion may cause complications by reducing patients ability
to fight off infection and respond to the stress that surgery puts
on the body, as well as (rarely) by transmitting viral infections
present in donor blood.
Professor Reeves said: During this trial, patients whose
haemoglobin level drops below the level at which transfusion is
conventionally given will either be given a transfusion (more or
less as they are now) or only when the haemoglobin level drops to a
lower, more restrictive level.
The primary outcome will be the number of patients affected by
sepsis stroke, heart attack or kidney failure during the first
three months after surgery.
We believe that withholding transfusion until the lower
haemoglobin level is reached will reduce both complications and
hospital costs.
For full details about the project go to www.hta.ac.uk/1729
Note to editors:
Professor Barnaby Reeves and Gavin Murphy can be contacted for
media interviews through the University of Bristol Press Office,
tel (0117) 331 7276 or University Hospitals Bristol NHS Foundation
Trust press office, tel (0117) 342 3629.
The research project, entitled A multi-centre randomised
controlled trial of Transfusion Indication Threshold Reduction on
transfusion rates, morbidity and healthcare resource use following
cardiac surgery (TITRe 2) is a three-year project funded by a grant
of £940,067 by the National Institute for Health Research Health
Technology Assessment (NIHR HTA) programme.
1.
The HTA programme is a programme of the National Institute for
Health Research (NIHR) and produces high quality research
information about the effectiveness, costs, and broader impact of
health technologies for those who use, manage and provide care in
the NHS. It is the largest of the NIHR programmes and publishes the
results of its research in the Health Technology Assessment
journal, with over 400 issues published to date. The journals 2007
Impact Factor (3.87) ranked it in the top ten per cent of medical
and health-related journals. All issues are available for download
free of charge from the website, www.hta.ac.uk. The HTA programme
is co-ordinated by the NETSCC, Health Technology Assessment, based
at the University of Southampton.
2.
The NIHR provides the framework through which the research staff
and research infrastructure of the NHS in England is positioned,
maintained and managed as a national research facility. The NIHR
provides the NHS with the support and infrastructure it needs to
conduct first-class research funded by the Government and its
partners alongside high-quality patient care, education and
training. Its aim is to support outstanding individuals (both
leaders and collaborators), working in world class facilities (both
NHS and university), conducting leading edge research focused on
the needs of patients. www.nihr.ac.uk
