Randomized Trialhigh evidence
Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk: The TOP Randomized Clinical Trial.
JAMA·December 23, 2025·PMID 41205227
Why it mattersCurrent guidelines recommend a restrictive transfusion threshold of 7 g/dL, but evidence in high-cardiac-risk surgical patients has been limited. This large RCT provides direct evidence that a liberal strategy does not reduce major ischemic events or death, supporting restrictive transfusion as safe even in this vulnerable population.
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