Acute cardiac care & resuscitationRandomised controlled trial
Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk
- Randomised controlled trial
- parallel
- single-blind
- superiority
- multicentre (16 Veterans Affairs Medical Centers)
- Enrolled February 2018 to March 2023
Authors' conclusion
After major vascular or general surgery operations among patients at high risk of a cardiac event, a liberal transfusion strategy did not reduce 90-day death or major ischemic outcome rates compared with a restrictive strategy.
Study context
- Population
- Veterans (≥18 y) at high cardiac risk undergoing major vascular or general surgery with postoperative hemoglobin <10 g/dL, US, 2018–20231,424 analysed
- Participants
- 1,428 veterans
- Comparison
- Liberal vs restrictive postoperative transfusion strategy
- Liberaln = 714
- Restrictiven = 714reference
- Primary endpoint
- Composite of:
- All-cause death
- MI
- Coronary revascularization
- Acute kidney failure
- Ischemic stroke
- Follow-up
- 90 days after randomization
Primary result
As reported in the abstract
Relative risk
0.90
95% CI 0.65–1.24
Events by treatment group
Liberal vs Restrictive
RR 0.90 (95% CI 0.65–1.24)
Secondary outcomes
| Outcome | Liberal | Restrictive | RR (99% CI) | |
|---|---|---|---|---|
| Cardiac complications without MI (arrhythmias, HF, nonfatal cardiac arrest) | 5.9% | 9.9% | 0.59 (0.36–0.98) | |
| 0.20.5125Relative risk (log scale) |
| Outcome | mean hemoglobin difference (g/dL) |
|---|---|
| Hemoglobin difference between strategies · day 5 after randomization | 2.0 |
- Cardiac complications without MI (arrhythmias, HF, nonfatal cardiac arrest): 1 of 5 secondary end points
- Cardiac complications without MI (arrhythmias, HF, nonfatal cardiac arrest): 38 of 647 vs 67 of 678
Original publication
Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk. JAMA. Published 23 December 2025. doi:10.1001/jama.2025.20841
Summarised from the published abstract; every number is checked against it