Breakthroughs in blood: Advancing practice through research

Date of webinar: Monday June 16^th, 2025 (1pm-2pm (ET))

Webinar details: The FARES-II trial: Is it time to replace FP with PCC as first-line therapy for coagulopathic bleeding in cardiac surgery?

Key takeaways

1. The FARES-II study found that prothrombin complex concentrates (PCCs) were superior to frozen plasma (FP) for hemostatic response in the management of excessive bleeding related to coagulation factor deficiency in patients undergoing cardiac surgery.
2. The greater hemostatic efficacy of PCC over FP reported in the FARES-II study was shown across multiple endpoints and was not accompanied by an increase in thromboembolic events.
3. The FARES-II study found that patients who received PCC had fewer adverse events and acute kidney injuries compared to those who received FP.

Publications

Prothrombin Complex Concentrate vs Frozen Plasma for Coagulopathic Bleeding in Cardiac Surgery: The FARES-II Multicenter Randomized Clinical Trial

Webinar recording

Suggested citation
Karkouti, K. (2025). The FARES-II trial: Is it time to replace FP with PCC as first-line therapy for coagulopathic bleeding in cardiac surgery? [Slide deck]. Breakthroughs in blood: Advancements into Action webinar series. Canadian Blood Services.  https://profedu.blood.ca/en/transfusion/best-practices/breakthroughs-blood-advancing-practice-through-research

Resources

FAQ: Use of prothrombin complex concentrates (PCCS) in cardiac surgery for postoperative coagulopathy.

Suggested citation
Callum, J. & Karkouti, K. (2025). FAQ: Use of prothrombin complex concentrates (PCCS) in cardiac surgery for postoperative coagulopathy. [Slide deck]. Breakthroughs in blood: Advancements into Action webinar series. Canadian Blood Services. https://profedu.blood.ca/en/transfusion/best-practices/breakthroughs-blood-advancing-practice-through-research

Date of webinar:  October 25, 2024
Webinar details:  The HEMOTION trial: How do we integrate this new knowledge into our clinical practice? 

Key takeaways

1. Among traumatic brain injury patients, the standard of care evaluation outcome measures should not focus on mortality alone but include mortality with long-term functional outcomes. 
2. The HEMOTION trial did not observe a statistically significant decrease in the risk of an unfavourable neurological outcome at 6 months in critically ill adult patients with traumatic brain injury and anemia based on the Glasgow Outcome Scale extended between liberal and restrictive transfusion strategies. However, the confidence intervals suggest that the possibility of a 13.7% absolute reduction or a 2.9% increase in risk of an unfavourable outcome with a liberal transfusion strategy cannot be excluded.
3. The HEMOTION trial observed a potential beneficial effect of liberal transfusion strategies on measures of functional independence and quality of life compared to a restrictive transfusion strategy.
4. The HEMOTION trial did not observe a statistically significant difference in mortality between patients who received a liberal or restrictive transfusion strategy.

Publications

Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury  

Suggested citation:
Turgeon A. The HEMOTION Trial: How do we integrate this new knowledge in our Practice?, [webinar] Breakthroughs in blood: Advancements into action webinar series; Canadian Blood Services; 2024 [cited YYYY MM DD]. Available from: https://profedu.blood.ca/en/transfusion/best-practices/breakthroughs-blood-advancing-practice-through-research

Resources 

Summary of Traumatic Brain Injury Research: A downloadable slide deck that summarizes key Traumatic Brain Injury (TBI) literature.

Suggested citation:
Canadian Blood Services. Summary of Traumatic Brain Injury (TBI) Literature [slide deck] Breakthroughs in blood: Advancements into Action webinar series. Canadian Blood Services. 2025 [updated 2025-01-07; cited YYYY MM DD]. Available from: https://profedu.blood.ca/en/transfusion/best-practices/breakthroughs-blood-advancing-practice-through-research

Date of webinar: September 6, 2024 
Webinar details: The International Collaboration for Transfusion Medicine Guidelines’ (ICTMG) Use of Intravenous Albumin guideline: Moving evidence into practice 

Key takeaways

1. Albumin is a human-derived blood product manufactured from donated plasma that is used in a wide range of clinical settings to improve hemodynamics, facilitate fluid removal, and manage complications of cirrhosis with highly variable practice between regions.  
2. Albumin has been associated with adverse consequences in some cases including fluid overload, hypotension, hemodilution requiring red blood cell transfusion and anaphylaxis.
3. ICTMG's Use of Intravenous Albumin guideline provides clinicians with actionable, evidence-based recommendations on indications for albumin use. Twelve of the fourteen recommendations do not suggest albumin use in a wide variety of clinical situations where it is commonly transfused.

Publications 

ICTMG publications

• Guideline: Intravenous albumin | ICTMG 
• Systematic review of the evidence for patients undergoing cardiovascular surgery: Intravenous albumin in cardiac and vascular surgery: a systematic review and meta-analysis - British Journal of Anaesthesia (bjanaesthesia.org) 

Other publications

• CHEST Critical Care Commentary (July 2024): Use of albumin in critically ill patients | CHEST Physician (mdedge.com)

Resources and tools to support practice change

1.  Mythbusters resource: A downloadable resource to address common myths about intravenous albumin and encourage evidence-based decisions regarding its use.

2.  Knowledge Mobilization project: The ICTMG is undertaking a 1-year knowledge mobilization (KM) project to support the uptake of guideline recommendations into clinical practice by developing and utilizing knowledge mobilization resources, tools, and strategies. To access resources developed through this project, visit ICTMG.org/albumin where updates will be posted as they become available.

3.  Social media package: A downloadable set of images and sample text optimized for social media. Use these items to create posts sharing information about the ICTMG Albumin guideline and help address common myths about intravenous albumin on various platforms. 

• Sample text (to be copied into social media posts):  

DYK: 12/14 recommendations in ICTMG’s Use of Intravenous Albumin guideline do not support #albumin as a first-line treatment in a range of patient settings. Swipe to learn more about common myths associated with albumin use.  

Access the guideline and additional resources on ictmg.org/albumin. Publishing evidence-based #clinicalguidelines moves the International Collaboration for Transfusion Medicine Guidelines (ICTMG) closer to its vision of “The right transfusion, always, everywhere”. @CanadasLifeline is proud to support this vision by hosting the ICTMG Secretariat.
#Albumin #TransfusionMedicine #ClinicalPractice #Cirrhosis #CriticalCare   #CardiacSurgery #KidneyReplacementTherapy 

Date of webinar: December 1, 2023
Webinar details: Restrictive or liberal transfusion strategy in myocardial infarction and anemia

Key takeaways

1. The MINT trial did not demonstrate a statistically significant difference in the rate of 30-day death or recurrent MI in patients with acute MI and anemia assigned to a restrictive compared to a liberal transfusion strategy 
2. While not statistically significant, the point estimates for the primary outcome and secondary outcomes consistently favored a liberal transfusion strategy 
3. Heart failure and other safety outcomes were comparable in the restrictive and liberal transfusion groups 

Publication

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia | NEJM

Webinar recording

Resources and tools to support practice change

1.  Questions and answers - Restrictive or liberal transfusion strategy in myocardial infarction and anemia

Date of webinar: November 17, 2023
Webinar details: Anemia in hospitalized patients: Vampirism and other tales

Key takeaways

1. Small volume sample collection tubes can be successfully implemented without additional costs or impacts on laboratory testing results.
2. Small volume sample collection tubes reduce diagnostic blood loss and iatrogenic anemia.
3. Small volume sample collection tubes reduce volumes of blood transfused in critical care patients.

Publication

Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial - PubMed (nih.gov)

Webinar recording