Volume 59, Issue 6 pp. 1997-2006
TRANSFUSION COMPLICATIONS

Can furosemide prevent transfusion-associated circulatory overload? Results of a pilot, double-blind, randomized controlled trial

Jacob Pendergrast

Corresponding Author

Jacob Pendergrast

University Health Network, Toronto, Ontario, Canada

University of Toronto, Toronto, Ontario, Canada

Address reprint requests to: Jacob Pendergrast, 3EC-306 200 Elizabeth Street, Toronto General Hospital, Toronto, Ontario, M4E 3J1; e-mail: [email protected].Search for more papers by this author
Chantal Armali

Chantal Armali

University Health Network, Toronto, Ontario, Canada

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Christine Cserti-Gazdewich

Christine Cserti-Gazdewich

University Health Network, Toronto, Ontario, Canada

University of Toronto, Toronto, Ontario, Canada

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Mark Hansen

Mark Hansen

University of Toronto, Toronto, Ontario, Canada

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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Alex Kiss

Alex Kiss

Institute of Clinical and Evaluative Sciences, Toronto, Ontario, Canada

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Lani Lieberman

Lani Lieberman

University Health Network, Toronto, Ontario, Canada

University of Toronto, Toronto, Ontario, Canada

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Nagina Parmar

Nagina Parmar

University Health Network, Toronto, Ontario, Canada

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Damon Scales

Damon Scales

University of Toronto, Toronto, Ontario, Canada

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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Robert Skeate

Robert Skeate

Canadian Blood Services, Toronto, Ontario, Canada

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Jeannie Callum

Jeannie Callum

University of Toronto, Toronto, Ontario, Canada

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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Yulia Lin

Yulia Lin

University of Toronto, Toronto, Ontario, Canada

Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

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First published: 28 March 2019
Citations: 13

Abstract

BACKGROUND

Transfusion-associated circulatory overload (TACO) is a leading cause of transfusion-attributable morbidity. It is unclear whether diuretics are safe and effective in preventing this reaction.

MATERIALS AND METHODS

In a pilot controlled feasibility trial, inpatients 65 years or older ordered a single unit of red blood cells were randomized to pre-transfusion furosemide 20 mg or placebo intravenously. Primary outcome was the ability to enroll 80 patients within a 2-month time period. Secondary feasibility outcomes included proportion of RBC transfusions meeting eligibility criteria, proportion of eligible patients enrolled, and compliance to study protocol. Clinical outcomes included the incidence of TACO and associated complications.

RESULTS

Nine months of enrollment were required for 80 patients to complete the study, due primarily to fewer transfusions than expected meeting eligibility criteria and lower than anticipated consent rates. Protocol compliance was below target due to missing chart documentation of patient fluid balance, and transfusion infusion time. Blinding was maintained throughout the study and treatment arms were well-balanced. A single case of TACO occurred in each arm, for an overall incidence of 2.5%. No differences in peri-transfusion vital signs, B-natriuretic peptide, or signs of furosemide toxicity were observed.

CONCLUSION

The study protocol was not feasible as designed, primarily due to challenges in patient enrollment. Modifications to trial design to improve feasibility in future studies have been identified.

CONFLICTS OF INTEREST

The authors have disclosed no conflicts of interest.

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