Document Detail


The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS) study: a randomised, controlled, multicentre clinical trial.
MedLine Citation:
PMID:  23352054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: No consensus exists on whether preoperative blood transfusions are beneficial in patients with sickle-cell disease. We assessed whether perioperative complication rates would be altered by preoperative transfusion.
METHODS: We did a multicentre, randomised trial. Eligible patients were aged at least 1 year, had haemoglobin SS or Sβ(0)thalassaemia sickle-cell-disease subtypes, and were scheduled for low-risk or medium-risk operations. Patients were randomly assigned no transfusion or transfusion no more than 10 days before surgery. The primary outcome was the proportion of clinically important complications between randomisation and 30 days after surgery. Analysis was by intention to treat.
FINDINGS: 67 (96%) of 70 enrolled patients-33 no preoperative transfusion and 34 preoperative transfusion-were assessed. 65 (97%) of 67 patients had the haemoglobin SS subtype and 54 (81%) were scheduled to undergo medium-risk surgery. 13 (39%) of 33 patients in the no-preoperative-transfusion group had clinically important complications, compared with five (15%) in the preoperative-transfusion group (p=0.023). Of these, 10 (30%) and one (3%), respectively, had serious adverse events. The unadjusted odds ratio of clinically important complications was 3.8 (95% CI 1.2-12.2, p=0.027). 10 (91%) of 11 serious adverse events were acute chest syndrome (nine in the no-preoperative-transfusion group and one in the preoperative-transfusion group). Duration of hospital stay and readmission rates did not differ between study groups.
INTERPRETATION: Preoperative transfusion was associated with decreased perioperative complications in patients with sickle-cell disease in this trial. This approach could, therefore, be beneficial for patients with the haemoglobin SS subtype who are scheduled to undergo low-risk and medium-risk surgeries.
FUNDING: NHS Blood and Transplant.
Authors:
Jo Howard; Moira Malfroy; Charlotte Llewelyn; Louise Choo; Renate Hodge; Tony Johnson; Shilpi Purohit; David C Rees; Louise Tillyer; Isabeau Walker; Karin Fijnvandraat; Melanie Kirby-Allen; Eldon Spackman; Sally C Davies; Lorna M Williamson
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2013-01-23
Journal Detail:
Title:  Lancet     Volume:  381     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-18     Completed Date:  2013-03-22     Revised Date:  2014-02-20    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  930-8     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 Elsevier Ltd. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Acute Chest Syndrome / etiology,  prevention & control*
Adolescent
Adult
Anemia, Sickle Cell / blood,  complications,  therapy*
Blood Transfusion*
Canada
Child
Child, Preschool
Europe
Female
Hemoglobin, Sickle / metabolism*
Humans
Infant
Male
Odds Ratio
Perioperative Period
Postoperative Complications / prevention & control*
Surgical Procedures, Operative* / adverse effects
Treatment Outcome
beta-Thalassemia / therapy
Grant Support
ID/Acronym/Agency:
MC_U122870183//Medical Research Council
Chemical
Reg. No./Substance:
0/Hemoglobin, Sickle
Comments/Corrections
Comment In:
Lancet. 2013 Mar 16;381(9870):886-8   [PMID:  23352053 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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