TRICC
Trial question
Is restrictive strategy of transfusion superior to liberal strategy in critically ill patients with euvolemia who had hemoglobin concentrations < 9.0 g/dL within 72 hours after admission to ICU?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 838
838 patients (314 female, 524 male).
Inclusion criteria: critically ill patients with euvolemia who had hemoglobin concentrations < 9.0 g/dL within 72 hours after admission to ICU.
Key exclusion criteria: age < 16 years; inability to receive blood products; active blood loss at the time of enrollment ,chronic anemia; pregnancy; brain death or imminent death.
Interventions
N=418 restrictive blood transfusion therapy (transfusion when hemoglobin concentration < 7.0 g/dL, hemoglobin concentrations maintained at 7.0-9.0 g/dL).
N=420 liberal blood transfusion therapy (transfusion when hemoglobin concentration < 10.0 g/dL, hemoglobin concentration maintained at 10.0-12.0 g/dL).
Primary outcome
Death at 30 days
18.7%
23.3%
23.3 %
17.5 %
11.7 %
5.8 %
0.0 %
Restrictive blood transfusion
therapy
Liberal blood transfusion
therapy
No significant
difference ↔
No significant difference in death at 30 days (18.7% vs. 23.3%; AD 4.7%, 95% CI -0.84 to 10.2).
Secondary outcomes
Significant decrease in death at 30 days among patients with APACHE II score ≤ 20 (8.7% vs. 16.1%; RR 0.54, 95% CI 1 to 13.6).
Borderline significant increase in death in the hospital (22.3% vs. 28.1%; AD 5.8%, 95% CI -0.3 to 11.7).
No significant difference in length of stay in the hospital (34.8 days vs. 35.5 days; AD 0.7 days, 95% CI -1.9 to 3.4).
Safety outcomes
No significant differences in rates of cardiac events, infectious complications, multiorgan failure.
Significant differences in pulmonary edema (5.3% vs. 10.7%), MI (0.7% vs. 2.9%).
Conclusion
In critically ill patients with euvolemia who had hemoglobin concentrations < 9.0 g/dL within 72 hours after admission to ICU, restrictive blood transfusion therapy was not superior to liberal blood transfusion therapy with respect to death at 30 days.
Reference
Hebert PC, Wells G, Blajchman MA et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999 Feb 11;340(6):409-17.
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