Earlier Blood Transfusions Cut Heart Failure Risk in Cardiac Surgery Patients

A groundbreaking study presented at the American Heart Association's Scientific Sessions 2025 reveals that earlier blood transfusions may significantly benefit patients with heart disease undergoing major surgery. The Transfusion Trigger after Operations in High Cardiac Risk Patients (TOP) trial, involving over 1,400 U.S. military veterans, compared two transfusion strategies: one providing blood when hemoglobin levels dropped below 10 g/dL (early/liberal approach) versus waiting until levels fell below 7 g/dL (later/restrictive approach). While both strategies showed similar rates of severe complications like death, heart attack, kidney failure, need for heart procedures, or stroke, the early transfusion approach demonstrated a remarkable 41% reduction in irregular heartbeat and heart failure complications.

Led by Dr. Panos Kougias of SUNY Downstate Health Sciences University, the research challenges conventional medical wisdom that restricting transfusions might prevent heart overload. Instead, the findings suggest that persistent anemia from blood loss may strain compromised hearts more than transfusion volume itself. The study found that irregular heart rhythms and heart failure occurred in just 5.9% of early transfusion patients compared to 9.9% in the restrictive group. This unexpected outcome indicates that for high-risk cardiac patients, maintaining hemoglobin levels above the traditional threshold could protect against certain cardiovascular complications, though the research requires confirmation through further investigation.

The study, simultaneously published in JAMA and funded by the Veterans Affairs Office of Research and Development, represents a potential paradigm shift in surgical care for cardiac patients. Dr. Kougias emphasized that "a one-size-fits-all transfusion strategy may not be best," suggesting that personalized approaches based on individual patient risk profiles could optimize outcomes. While the research has limitations including predominantly male participants and potential bias from clinicians knowing treatment assignments, it opens important new avenues for improving surgical safety for the millions of patients with underlying heart conditions who undergo major procedures annually.