Restrictive vs. Liberal Red Blood Cell Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: A Systematic Review and Meta-Analysis

Objective: Anemia is frequent in patients with acute myocardial infarction (AMI), and the optimal red blood cell transfusion strategy for AMI patients with anemia is still controversial. We aimed to compare the efficacy of restrictive and liberal red cell transfusion strategies in AMI patients with anemia.Methods: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, and Clinicaltrials.gov, from their inception until March 2021. Studies designed to compare the efficacy between restrictive and liberal red blood cell transfusion strategies in patients with AMI were included. The primary outcome was all-cause mortality, including overall mortality, in-hospital or follow-up mortality. Risk ratios (RR) with 95% confidence intervals (CI) were presented and pooled by random-effects models.Results: The search yielded a total of 6,630 participants in six studies. A total of 2,008 patients received restrictive red blood cell transfusion while 4,622 patients were given liberal red blood cell transfusion. No difference was found in overall mortality and follow-up mortality between restrictive and liberal transfusion groups (RR = 1.07, 95% CI = 0.82–1.40, P = 0.62; RR = 0.89, 95% CI = 0.56–1.42, P = 0.62). However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion (RR = 1.22, 95% CI = 1.00–1.50, P = 0.05). No secondary outcomes, including follow-up reinfarction, stroke, and acute heart failure, differed significantly between the two groups. In addition, subgroup analysis showed no differences in overall mortality between the two groups based on sample size and design.Conclusion: Restrictive and liberal red blood cell transfusion have a similar effect on overall mortality and follow-up mortality in AMI patients with anemia. However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion. The findings suggest that transfusion strategy should be further evaluated in future studies.

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Restrictive versus liberal red cell transfusion strategies in patients with acute myocardial infarction: a systematic review and meta-analysis

10.21203/rs.3.rs-476215/v1 ◽

2021 ◽

Author(s):

Yuanhui Liu ◽

Yeshen Zhang ◽

Yuming Huang ◽

Nianjin Xie ◽

Lihuan Zeng ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Transfusion ◽

Red Cell ◽

Transfusion Strategy ◽

Restrictive Transfusion ◽

All Cause Mortality ◽

Red Cell Transfusion ◽

Liberal Transfusion ◽

Overall Mortality

Abstract BackgroundAnemia is frequent in patients with acute myocardial infarction(AMI), and the optimal red blood cell transfusion strategy for patients with AMI and anemia is still controversial. We aimed to compare the efficacy of restrictive and liberal red cell transfusion strategies in patients with AMI and anemia.MethodsWe systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, and Clinicaltrials.gov, from their inception until March 2021. Inclusion criteria were clinical trials that compared the efficacy of restrictive and liberal transfusion strategies in patients with AMI and anemia on all-cause mortality and major adverse cardiovascular events. The primary outcome was all-cause mortality, including overall mortality, in-hospital, or follow-up mortality. Risk ratios (RR) with 95% confidence intervals (CI) were presented and pooled by random-effects models. ResultsThe search yielded a total of 6630 participants in six studies. Among the included patients, the average age ranged from 69.0 to 79.5 years and 2950 (44.5%) were men. A total of 2008 patients received restrictive red blood transfusion while 4622 patients were given liberal red blood transfusion. No difference was found in overall mortality and follow-up mortality between restrictive and liberal blood transfusion groups (RR=1.07, 95% CI=0.82–1.40, P=0.62; RR=0.89, 95% CI=0.56–1.42, P=0.62). However, restrictive transfusion was associated with a higher risk of in-hospital mortality compared with liberal transfusion (RR=1.22, 95% CI=1.00–1.50, P=0.05). No secondary outcomes, including follow-up reinfarction, stroke, and acute heart failure, differed significantly between the two groups. In addition, subgroup analysis showed no differences in overall mortality between the two groups based on sample size and design.ConclusionRestrictive and liberal red blood transfusion have a similar effect on overall mortality and follow-up mortality in patients with AMI and anemia. However, restrictive transfusion was associated with a higher risk of in-hospital mortality compared with liberal transfusion. The findings suggest that transfusion strategy should be evaluated in the more future researches.

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BLOOD TRANSFUSION IN CARDIAC SURGERY- NEED TO FOLLOW BASICS!

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0703.01 ◽

2020 ◽

Vol 7 (3) ◽

Keyword(s):

Cardiac Surgery ◽

Blood Transfusion ◽

Blood Cell ◽

Red Blood Cell ◽

Red Blood Cell Transfusion ◽

Transfusion Strategy ◽

Transfusion Threshold ◽

Restrictive Transfusion ◽

Conflicting Evidence ◽

American Society

More and more data is coming in recent times about hazards of blood transfusion. In a landmark TRICC1 trial Euvolemic patients in the intensive care unit (ICU) with Hb<9 g/dl were randomized to a restrictive transfusion strategy for transfusion of PRBCs (transfused if Hb<7 g/dl to maintain Hb between 7 and 9 g/dl) or a liberal strategy (transfused if Hb<10 g/dl to maintain Hb 10-12 g/dl). Mortality was similar in both groups, indicating that liberal transfusions were not beneficial. An Updated Report by the American Society of AnaesthesiologistsTask Force on Perioperative Blood Management tells us restrictive red blood cell transfusion strategy may be safely used to reduce transfusion administration. It further states that The determination of whether hemoglobin concentrations between 6 and 10 g/dl justify or require red blood cell transfusion should be based on potential or actual on going bleeding (rate and magnitude), intravascular volume status, signs of organ ischemia, and adequacy of cardiopulmonary reserve. Should we extrapolate these guidelines in Cardiac surgery? TRACS2 trial concluded that among patients undergoing cardiac surgery, the use of a restrictive perioperative transfusion strategy compared with a more liberal strategy resulted in noninferior rates of the combined outcome of 30-day all-cause mortality and severe morbidity.They advocated use of restrictive strategy, but 5 years later, the authors 3concluded that A restrictive transfusion threshold after cardiac surgery was not superior to a liberal threshold with respect to morbidity or health care costs. With this conflicting evidence, by which way anaesthesiologist to go?

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