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A388
October 13, 2012
8:00:00 AM - 11:00:00 AM
Room Hall C-Area D
2011 STS/SCA Transfusion Guidelines: Advancing Knowledge of Contemporary Transfusion Practice
Aruna M. Kamath, M.D.,M.P.H., Roberta L. Hines, M.D., Shamsuddin Akhtar, M.B.,B.S.
Yale University School of Medicine, New Haven, Connecticut, United States
Introduction: In 2007 Society of Thoracic Surgeons (STS) and the Society of Cardiovascular Anesthesiologists (SCA) published guidelines for transfusion therapy. With recent advances in transfusion medicine and new pharmacologic agents, these guidelines haves been updated in 2011.1 The goal of this study was to determine if the recent guidelines have changed substantially based upon the number of recommendations provided, Class, Level of Evidence (LOE) and particular areas of change.

Methods: We evaluated the 2007 and 2011 STS/SCA Clinical Practice Guidelines: Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery.1, 2 Analysis of these two documents focused on: Level of Evidence (A, B, C) and Class (I, IIa, IIb, III) as per classification scheme outlined in the respective guidelines.

Results: The total number of recommendations increased from 57 to 72, an overall increase of 26%. Interestingly, the change represents modification or addition of 35 recommendations in 2011 guidelines. Most of the new recommendations were Class IIa (29%) or IIb (40%). Only 15% of the new recommendations were Class I recommendations. However, the number of Class I recommendations increased from 7 to 11 (57% increase). In terms of LOE, both in 2007 and 2011, most of the recommendations were based on LOE B (47%, 44%) followed by LOE C (30%, 29%). Only 23-26% of the recommendations were based on LOE A evidence. (Table 1) However, the number of LOE A recommendations increased dramatically from 13 to 19 (46% increase). Blood component therapy (plasma, PCC, factor VIII, allogeneic transfusion, plasmapharesis, recombinant factor VIIa, factor IX, Anti-thrombin III), saw the greatest area of change, from 2 to 12 recommendations.

Conclusion: This analysis shows that there has been a substantial increase in knowledge regarding blood transfusion, especially on blood component therapy, which has been incorporated in the new guidelines. This has resulted absolute increase in the number of recommendations especially LOE A and Class 1 recommendations. New STS/SCA transfusion guidelines are timely and should be incorporated into clinical practice.

References:

1. Ferraris VA et al: Ann Thorac Surg. 2011;91:944-82

2. Ferraris VA et al: Ann Thorac Surg. 2007;83:S27-86
Figure 1

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