The threshold or operative hemoglobin trigger for red blood cell transfustion pilot trial (TOPGUN-pilot)
Physicians who take care of patients while they are having surgery (anesthesiologists and
surgeons) are conflicted regarding the correct conditions under which blood transfusions
should be given during surgery. The major reason behind this conflict is that clinicians do not
have adequate evidence from clinical trials to guide their decisions during surgery. The
current proposal is for the TOPGUN-pilot clinical trial, which seeks to determine whether
moving ahead with a much larger and expensive definitive clinical trial is feasible. TOPGUN
will compare two different ways to give blood transfusions during surgery, one of which is
liberal (i.e. transfusions are given more readily) and one of which is restrictive (i.e.
transfusions are often held back). This pilot trial will enroll 480 Canadian patients having
surgery at 4 hospitals over one year. If feasibility is demonstrated, then the larger definitive
study that will enrol over 5,000 patients at 13 hospitals.
This research proposal is aligned with the Intramural Research Grant Program’s objective
given that it addresses the important problem of excessive blood transfusion in the operating
room. Additionally, the focus of this proposal is to evaluate whether a restrictive transfusion
strategy is safe for patients when compared with a liberal one. This will address two research
priorities identified by Canadian Blood Services, namely the promotion of appropriate blood
product utilization and the minimization of adverse effects of blood product transfusion.
The TOPGUN-pilot trial will demonstrate the feasibility of a larger definitive clinical trial.
Results from the full-scale TOPGUN trial will become a guide to help inform blood
transfusions in the operating room. If the restrictive transfusion strategy is proven safe,
TOPGUN has the potential to save thousands of units of blood in Canada every year.
surgeons) are conflicted regarding the correct conditions under which blood transfusions
should be given during surgery. The major reason behind this conflict is that clinicians do not
have adequate evidence from clinical trials to guide their decisions during surgery. The
current proposal is for the TOPGUN-pilot clinical trial, which seeks to determine whether
moving ahead with a much larger and expensive definitive clinical trial is feasible. TOPGUN
will compare two different ways to give blood transfusions during surgery, one of which is
liberal (i.e. transfusions are given more readily) and one of which is restrictive (i.e.
transfusions are often held back). This pilot trial will enroll 480 Canadian patients having
surgery at 4 hospitals over one year. If feasibility is demonstrated, then the larger definitive
study that will enrol over 5,000 patients at 13 hospitals.
This research proposal is aligned with the Intramural Research Grant Program’s objective
given that it addresses the important problem of excessive blood transfusion in the operating
room. Additionally, the focus of this proposal is to evaluate whether a restrictive transfusion
strategy is safe for patients when compared with a liberal one. This will address two research
priorities identified by Canadian Blood Services, namely the promotion of appropriate blood
product utilization and the minimization of adverse effects of blood product transfusion.
The TOPGUN-pilot trial will demonstrate the feasibility of a larger definitive clinical trial.
Results from the full-scale TOPGUN trial will become a guide to help inform blood
transfusions in the operating room. If the restrictive transfusion strategy is proven safe,
TOPGUN has the potential to save thousands of units of blood in Canada every year.
Principal Investigator / Supervisor
MARTEL, Guillaume
Co-Investigator(s) / Trainee
MCISAAC, Daniel
FERGUSSON, Dean
TINMOUTH, Alan
BREAU, Rodney
CARRIER, Francois Martin
VERRET, Michael
TALJAARD, Monica
BROUSSEAU, Karine
Institution
The Ottawa Hospital
Program
Intramural Research Grant Program
Province
Ontario
Total Amount Awarded
$400,000
Project Start Date
Project End Date