Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease

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• 作者：Jeffrey L. Carson ; MD^a ; ^{carson@umdnj.edu} ; Maria Mori Brooks ; PhD^b ; J. Dawn Abbott ; MD^c ; Bernard Chaitman ; MD^d ; Sheryl F. Kelsey ; PhD^b ; Darrell J. Triulzi ; MD^e ; Vankeepuram Srinivas ; MD^f ; Mark A. Menegus ; MD^f ; Oscar C. Marroquin ; MD^g ; Sunil V. Rao ; MD^h ; Helaine Noveck ; MPH^a ; Elizabeth Passano ; MS^b ; Regina M. Hardison ; MS^b ; Thomas Smitherman ; MD^g ; Tudor Vagaonescu ; MDⁱ ; Neil J. Wimmer ; MD^j ; David O. Williams ; MD^j
• 刊名：American Heart Journal
• 出版年：2013
• 出版时间：June, 2013
• 年：2013
• 卷：165
• 期：6
• 页码：964-971.e1
• 全文大小：518 K

文摘

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Background

Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels.

Methods

We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ¡Ý10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization.

Results

Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9 % ) in the liberal group and 14 (25.5 % ) in the restrictive group (risk difference = 15.0 % ; 95 % confidence interval of difference 0.7 % to 29.3 % ; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8 % ) compared to restrictive group (n = 7, 13.0 % ; P = .032).

Conclusions

The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.