Impacto da transfusão de hemácias no perioperatório de pacientes com anemia submetidos a cirurgia vascular não cardíaca de grande porte - revisão sistemática

Abstract

Knowing the appropriate parameters for indicating blood transfusion in the perioperative period of major vascular surgery is highly relevant for clinical practice. This study reviewed the scientific literature available in the main databases between March 11, 2024 and March 18, 2024 on the topic guided by the PISMA methodology.

All studies related to the association between anemia and clinical outcome, the association between transfusion and outcome, and the correlation between hematimetric parameters for indicating blood transfusion and the clinical/surgical outcome of patients undergoing major vascular surgery were included. Guidelines, consensuses, and other studies not related to the proposed approach were discarded.

6 studies (DESORMAIS et al., 2014, VELESCU et al., 2016, KOUGIAS et al., 2017, BODEWES et al., 2017, NANDHRA et al., 2020 and KIM et al., 2023) addressed the association between anemia and increased morbidity and mortality in patients with PAD and undergoing major vascular surgery, all showing a worse outcome of mortality and overall morbidity among patients with anemia during hospitalization. 7 publications (BURSI et al., 2009, NANJUNDAPPA et al., 2018, O’KEEFFE et al., 2010, TZE-WOEI; FARBER; HAMBURG, 2013, JOHNSON et al., 2022, OBI et al., 2015, WEDEL et al., 2019) described a relationship between perioperative red blood cell transfusion and mortality and morbidity within 30 days and in variable periods. The meta-analysis of these studies showed higher mortality within 30 days with RR = 3.27 using the random model for 95% CI. Two studies were found that evaluated the association between "trigger" for transfusion indication and surgical outcome. BUSH; PEVEC; HOLCROFT, 1997 in a sample of 99 patients found no statistical difference in the outcome with transfusion indicated for hemoglobin greater than 10 g/dL or between 9 and 10 g/dL. MØLLER et al., 2019 found in a sample of 58 patients lower mortality with transfusion to maintain HB > 9.7 g/dL in relation to hemoglobin tolerance between 8 and 9.7 g/dL, but without reaching statistical significance (p = 5.08). In a meta-analysis, there was no statistically significant difference between the liberal and restrictive strategies regarding the mortality outcome.