A restrictive versus liberal transfusion strategy to prevent myocardial injury in patients undergoing surgery for fractured neck of femur: a feasibility randomised trial (RESULT-NOF)

BackgroundThe optimum transfusion strategy in patients with fractured neck of femur is uncertain, particularly if there coexisting cardiovascular disease.MethodsWe conducted a prospective, single-centre, randomised feasibility trial two strategies. We randomly assigned undergoing surgery for to restrictive (haemoglobin, 70–90 g L−1) or liberal 90–110 throughout their hospitalisation. Feasibility outcomes included: enrolment rate, protocol compliance, difference haemoglobin, and blood exposure. The primary clinical outcome was myocardial injury using troponin estimations. Secondary included major adverse cardiac events, postoperative complications, duration hospitalisation, mortality, quality life.ResultsWe enrolled 200 (22%) 907 eligible patients, 62 (31%) showed decreased haemoglobin (to 90 L−1 less) were thus exposed the intervention. overall compliance 81% group 64% group. Haemoglobin concentrations similar preoperatively at day 1 but lower on 2 (mean [MD], 7.0 L−1; 95% confidence interval [CI], 1.6–12.4). Lowest within 30 days/before discharge (MD, 5.3 CI, 1.7–9.0). Overall, 58% received no compared 4% (difference proportion, 54.5%; 36.8–72.2). proportion 14/26 (54%, liberal) vs 24/34 (71%, restrictive), –16.7% (95% –41.3 7.8; P=0.18).ConclusionA strategies hip fracture clinically relevant feasible.Clinical registrationNCT03407573.