Hemoglobin Optimization for Coronary Bypass: A 10-Year Canadian Multicenter Experience

Yanagawa and colleagues evaluated the experience of 10 centers in Ontario, Canada, participating in the Ontario Transfusion Coordinator (ONTraC) program to determine if red blood cell transfusion rates were reduced by patient participation in the program and optimization of hemoglobin prior to coronary artery bypass grafting (CABG). The authors discuss the ONTraC program, noting that the first 60 consecutive patients undergoing CABG at each center each year were referred for assessment. After this, patients were referred only upon physician request. Over the 10 years following the start of the program, overall transfusion rates fell from 40.1% to 26.2%. Patients who were assessed by an ONTraC coordinator were more likely to be older, to be women, and to be anemic, but despite this, no differences were found in overall transfusion rates between patients who were and were not assessed. When patients were stratified by World Health Organization Anemia Classification, patients with both mild and moderate-to-severe anemia who were assessed prior to CABG had lower transfusion rates than patients with anemia who were not assessed.