This post hoc analysis included 405 women undergoing elective cardiac surgery with cardiopulmonary bypass, comparing acute normovolemic hemodilution (ANH) with usual care. Index-hospitalization red-cell transfusion occurred in 38.8% versus 44.6% (RR 0.87; 95% CI 0.69-1.10), without a statistically significant difference. Intraoperative hypotension was more frequent with ANH (16.0% versus 4.8%; RR 3.30; 95% CI 1.62-6.74). ANH was also associated with longer ICU stays (mean difference 21.13 hours; 95% CI 1.89-40.38) and hospital stays (1.92 days; 95% CI 0.14-3.70), while mortality and other postoperative complications did not differ significantly.
This exploratory analysis found no clear transfusion benefit in women, alongside signals of more hypotension and longer ICU and hospital stays with ANH. Confirmation in adequately powered studies is needed.
Study limitation: This post hoc female subgroup analysis is exploratory and requires confirmation in studies specifically powered for this population.
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