IJCS | Volume 32, Nº6, November / December 2019

575 1. Kassakian SZ, Yackel TR, Deloughery T, Dorr DA. Clinical Decision Support Reduces Overuse of Red Blood Cell Transfusions: Interrupted Time Series Analysis. Am J Med. 2016;129(6):636.e13-20. 2. Tempe DK, Khurana P. Optimal Blood Transfusion Practice in Cardiac Surgery. J Cardiothorac Vasc Anesth. 2018;32(6):2743-5. 3. Tagliari AP, Silveira LMV, Kochi AN, Souza AC,Gib MC; Freitas TM, et al. Int J Cardiovasc Sci. 2019;32(6):565-572. 4. Faed J. No Title. NZBlood. Guidelines for Management of Adverse Transfusion Reactions. [Cited in 2019 Oct 06]. Available from:https:// www.nzblood.co.nz/assets/Transfusion-Medicine/PDFs/Guidelines- for-Management-of-Adverse-Transfusion-Reactions-111I015.pdf. 5. Spahn DR, Goodnough LT. Alternatives to blood transfusion. Lancet. 2013;381( 9880) :1855-65 6. Hensley NB, Brown CH, Frank SM, Koch CG. The Goldilocks principle and perioperative red blood cell transfusion: Overuse, underuse, getting it just right. J Thorac Cardiovasc Surg. 2019. 7. Mazer CD, Whitlock RP, Fergusson DA, et al. Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery. N Engl J Med. 2017;377(22):2133-2144. 8. Mazer CD, Whitlock RP, Fergusson DA, et al. Six-Month Outcomes after Restrictive or Liberal Transfusion for Cardiac Surgery. N Engl J Med. 2018;379(13):1224-33. 9. Murphy GJ, Pike K, Rogers CA, Wordsworth S, Stokes EA, Angelini Gd, et al. Liberal or Restrictive Transfusion after Cardiac Surgery. N Engl J Med. 2015;372(11):997-1008. 10. Hajjar LA, Vincent JL, Galas FRB, Nakamura RE, Selva CM, Santos MH, et al. Transfusion requirements after cardiac surgery: The TRACS randomized controlled trial. JAMA. 2010;304(14):1559-67. 11. Dorneles Cde C, Bodanese LC, Guaragna JCVda C, Macagnan FE, Coelho JC, Borges AP,et al. O impacto da hemotransfusão na morbimortalidade pós-operatória de cirurgias cardíacas. Braz J Cardiovasc Surg. 2011;26(2):222-9. 12. Goel R, Chappidi MR, Patel EU, Ness PM, CushingMM, Frank SM, et al. Trends in red blood cell, plasma, and platelet transfusions in the United States, 1993-2014. JAMA. 2018;319(8):825-7. 13. Mueller MM, Van Remoortel H, Meybohm P, Aranko K, Aubron C, Burger C, et al. Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA. 2019;321(10):983-97. References Azevedo-Silva Transfusion in cardiac surgery Int J Cardiovasc Sci. 2019;32(6):573-575 Editorial both in the immediate postoperative period 7 and within six months after surgery. 8 Likewise, Murphy e al. 9 concluded in their studies that there was no difference regarding postoperative complications and costs when using a restrictive or liberal threshold for transfusion. Also, in the TRICS III study, 7 more than half of the patients were older than 74 years old, demonstrating that restrictive transfusion protocols can also be used in the elderly population. The TRACS study, 10 conducted with a group of Brazilian patients in 2010, had already shown the non-inferiority of the restrictive transfusion strategy in patients undergoing cardiac surgery within 30 days. Hensley et al., 6 demonstrated that transfusion is more common in patients reoperated for cardiac surgery, despite the use of PBM. Dorneles et al., 11 also found more infectious complications and acute kidney injury, and longer hospital stay in patients undergoing cardiac surgery who received blood transfusion. These results corroborate the findings of Tagliari et al. 3 Unnecessary transfusion is a risk to the patient, in addition to increasing the cost of treatment and consuming limited financial resources that may not be available when needed. 6 Despite available guidelines, changes are slow in the real world. Many professionals are unaware of or do not adhere to current recommendations. 6 Guidelines can only bring benefits to patients when implemented, 2 andmany transfusions are performed due to the ready availability of blood. Despite these setbacks, red blood cell transfusions have fallen worldwide, although this has not been seen in platelet and plasma concentrate transfusions. 12,13 Considering the risks and benefits of blood transfusion, restrictive transfusion thresholds should be considered the standard for cardiac surgery, but attention should be paid to the peculiarities of each patient. This is an open-access article distributed under the terms of the Creative Commons Attribution License