Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge Clustered Randomized Controlled Trial
Primary resultResult — go to the resultAdjusted relative risk 0.91 95% CI 0.85–0.98Authors' conclusion
Implementation of point-of-care hemostatic testing within the context of an integrated transfusion algorithm reduces red blood cell transfusions, platelet transfusions, and major bleeding following cardiac surgery.
Study context
- Population
- Consecutive patients undergoing cardiac surgery with cardiopulmonary bypass at 12 hospitals, 2014–2015
- Participants
- 7,402 patients · 12 hospitals
- Comparison
- Point-of-care-based transfusion algorithm vs standard hemostatic testing
- Interventionn = 3,847
- Controln = 3,555reference
- Primary endpoint
- Red blood cell transfusion
- Follow-up
- Surgery to postoperative day 7
Methodological detailspragmatic, multicentre, stepped-wedge cluster, All outcomes and analyses prespecified, Implementation order randomly assigned; 2 hospitals at a time in 1-month intervals
- Pragmatic
- Multicentre
- Stepped-wedge cluster
- All outcomes and analyses prespecified
- Implementation order randomly assigned; 2 hospitals at a time in 1-month intervals
Primary result
As reported in the abstract
Adjusted relative risk
0.91
95% CI 0.85–0.98
P = 0.02
Intervention vs Control
adjusted RR 0.91 (95% CI 0.85–0.98); P = 0.02
Further findings
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Platelet transfusionNNT 16.7 | 0.77 (0.68–0.87) | P < 0.001 | |
| 0.512Relative risk (log scale) |
Other blood product transfusions
- No effect on other blood product transfusions
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Major bleedingNNT 22.6 | 0.83 (0.72–0.94) | P = 0.004 | |
| 0.512Relative risk (log scale) |
- Major bleeding: overall 1773 (24.1%) patients
Major complications
- No effect on major complications
- Overall 740 (10.2%) patients
Original publication
Point-of-Care Hemostatic Testing in Cardiac Surgery: A Stepped-Wedge Clustered Randomized Controlled Trial. Circulation. Published 21 September 2016. doi:10.
Summarised from the published abstract; every number is checked against it