Hypovolemic Phlebotomy Beneficial Before Liver Resection

WEDNESDAY, Dec. 11, 2024 (HealthDay News) — For patients undergoing liver resection, hypovolemic phlebotomy reduces perioperative red blood cell transfusions compared with usual care, according to a study published online Dec. 9 in The Lancet Gastroenterology and Hepatology.

Guillaume Martel, M.D., from the University of Ottawa in Ontario, Canada, and colleagues conducted a superiority, randomized controlled trial to examine whether hypovolemic phlebotomy before liver resection is superior to usual care for reducing red blood cell transfusions. A total of 486 patients were randomly assigned to receive hypovolemic phlebotomy (removal of 7 to 10 mL/kg of whole blood without volume replacement) or usual care (245 and 241 participants, respectively); 22 and 18 patients, respectively, were excluded from the primary analysis population as they did not undergo liver resection.

The researchers found that 8 and 16 percent of patients assigned to hypovolemic phlebotomy and usual care, respectively, had a perioperative red blood cell transfusion by 30 days (difference, −8.8 percentage points; adjusted risk ratio, 0.47). Overall, 17 and 16 percent of patients allocated to hypovolemic phlebotomy and usual care, respectively, had severe complications to 30 days; overall complications to 30 days occurred in 61 and 52 percent, respectively. No postoperative mortality was seen to 90 days.

“Use of hypovolemic phlebotomy before liver transection resulted in significantly fewer perioperative red blood cell transfusions than with usual care,” the authors write.

Several authors disclosed ties to the pharmaceutical industry.

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