PRICE-2
Trial question
What is the effect of hypovolemic phlebotomy in patients undergoing hepatic resection?
Study design
Multi-center
Single blinded
RCT
Population
Characteristics of study participants
44.0% female
56.0% male
N = 446
446 patients (195 female, 251 male).
Inclusion criteria: adult patients at higher risk of blood loss undergoing hepatic resection.
Key exclusion criteria: age < 18 years; preoperative hemoglobin < 100 g/L; GFR < 60 mL/min; abnormal coagulation parameters; evidence of hepatic metabolic disorder; active cardiac conditions; history of significant cerebrovascular disease; history of significant peripheral vascular disease.
Interventions
N=223 hypovolemic phlebotomy (removal of 7-10 mL/kg of whole blood without volume replacement before liver transection).
N=223 usual care (standard of care with maintenance of standard anesthesia).
Primary outcome
Perioperative red blood cell transfusion at 30 days
8%
16%
16.0 %
12.0 %
8.0 %
4.0 %
0.0 %
Hypovolemic
phlebotomy
Usual
care
Significant
decrease ▼
NNT = 12
Significant decrease in perioperative RBC transfusion at 30 days (8% vs. 16%; RR 0.47, 95% CI 0.27 to 0.82).
Secondary outcomes
No significant difference in severe complications at 30 days (17% vs. 16%; RR 1.06, 95% CI 0.7 to 1.61).
No significant difference in overall complications at 30 days (61% vs. 52%; RR 1.08, 95% CI 0.92 to 1.25).
Conclusion
In adult patients at higher risk of blood loss undergoing hepatic resection, hypovolemic phlebotomy was superior to usual care with respect to perioperative RBC transfusion at 30 days.
Reference
Guillaume Martel, François Martin Carrier, Christopher Wherrett et al. Hypovolaemic phlebotomy in patients undergoing hepatic resection at higher risk of blood loss (PRICE-2): a randomised controlled trial. Lancet Gastroenterol Hepatol. 2025 Feb;10(2):114-124.
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