We appreciate the comments made by the reader about the results of our systematic review investigating the association between adverse clinical outcomes after coronary artery bypass graft (CABG) surgery and perioperative blood transfusions. We are grateful for the opportunity to respond to these concerns as they reflect a common misinterpretation of the methods used for our review. We conducted a rigorous review of the literature to determine if there was an association between perioperative blood transfusions and postoperative adverse outcomes. We did not conduct original research. To determine if transfusions caused adverse outcomes would require a randomized controlled trial, which would be unethical given the well-known benefits of blood and volume replacement.

We concur that CABG surgery is 1 of the most invasive types of surgical interventions, and bleeding is a relatively common postoperative complication. Blood transfusions have improved hemodynamic indices such as...

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