Loop diuretics for patients receiving blood transfusions.
Author(s): Sarai M(1), Tejani AM.
Affiliation(s): Author information:
(1)College of Medicine, Kansas City University of Medicine & Biosciences, 1750 E
Independence Ave, Kansas City, Missouri, USA.
Publication date & source: 2015, Cochrane Database Syst Rev. , 2:CD010138
BACKGROUND: Blood transfusions are associated with significant morbidity and
mortality. Prophylactic administration of loop diuretics (furosemide, bumetanide,
ethacrynic acid, or torsemide) is common practice, especially among people who
are at risk for circulatory overload, pulmonary oedema or both.
OBJECTIVES: This review aimed to determine if the prophylactic administration of
loop diuretics (furosemide, bumetanide, ethacrynic acid, or torsemide) provides a
therapeutic advantage (that is, a favourable risk benefit ratio) in adults and
children who are recipients of any blood product transfusion versus placebo, no
treatment, or general fluid restriction measures.
SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 13
January 2015 through contact with the Trials' Search Co-ordinator using search
terms relevant to this review.
SELECTION CRITERIA: All randomised controlled trials (RCTs) and quasi-RCTs
assessing a loop diuretic in patients receiving any blood transfusion were
considered for inclusion.
DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality
and extracted data. Study authors were contacted for additional information.
Results were to be expressed as risk ratios (RR) and their 95% confidence
intervals (CI) for dichotomous outcomes, and mean difference (MD) and 95% CI for
continuous outcomes. Mean effect sizes were to be calculated using the
random-effects models.
MAIN RESULTS: We included four studies that involved 100 participants. Furosemide
was the only diuretic investigated in all four studies.None of the included
studies assessed the clinically important outcomes noted in our protocol. The
studies focused on various markers of respiratory function. An improvement in
fraction of inspired oxygen (in favour of furosemide) was noted in one study. An
improvement in pulmonary capillary wedge pressure (in favour of furosemide) was
noted in two studies.
AUTHORS' CONCLUSIONS: There was insufficient evidence to determine whether
premedicating people undergoing blood transfusion with loop diuretics prevents
clinically important transfusion-related morbidity. Due to the continued use of
prophylactic loop diuretics during transfusions, and because this review
highlights the absence of evidence to justify this practice, well-conducted RCTs
are needed. Given the high mortality, severe morbidity and increasing incidence
of transfusion-associated circulatory overload, determining the therapeutic
utility of pre-transfusion loop diuresis is an urgent need.
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