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Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
Am Heart J. 2013 Jun; 165(6):964-971.e1.AH

Abstract

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 ≥10 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.

Authors+Show Affiliations

Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA. carson@umdnj.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

23708168

Citation

Carson, Jeffrey L., et al. "Liberal Versus Restrictive Transfusion Thresholds for Patients With Symptomatic Coronary Artery Disease." American Heart Journal, vol. 165, no. 6, 2013, pp. 964-971.e1.
Carson JL, Brooks MM, Abbott JD, et al. Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J. 2013;165(6):964-971.e1.
Carson, J. L., Brooks, M. M., Abbott, J. D., Chaitman, B., Kelsey, S. F., Triulzi, D. J., Srinivas, V., Menegus, M. A., Marroquin, O. C., Rao, S. V., Noveck, H., Passano, E., Hardison, R. M., Smitherman, T., Vagaonescu, T., Wimmer, N. J., & Williams, D. O. (2013). Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. American Heart Journal, 165(6), 964-e1. https://doi.org/10.1016/j.ahj.2013.03.001
Carson JL, et al. Liberal Versus Restrictive Transfusion Thresholds for Patients With Symptomatic Coronary Artery Disease. Am Heart J. 2013;165(6):964-971.e1. PubMed PMID: 23708168.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. AU - Carson,Jeffrey L, AU - Brooks,Maria Mori, AU - Abbott,J Dawn, AU - Chaitman,Bernard, AU - Kelsey,Sheryl F, AU - Triulzi,Darrell J, AU - Srinivas,Vankeepuram, AU - Menegus,Mark A, AU - Marroquin,Oscar C, AU - Rao,Sunil V, AU - Noveck,Helaine, AU - Passano,Elizabeth, AU - Hardison,Regina M, AU - Smitherman,Thomas, AU - Vagaonescu,Tudor, AU - Wimmer,Neil J, AU - Williams,David O, Y1 - 2013/04/08/ PY - 2012/11/27/received PY - 2013/03/05/accepted PY - 2013/5/28/entrez PY - 2013/5/28/pubmed PY - 2013/7/24/medline SP - 964 EP - 971.e1 JF - American heart journal JO - Am Heart J VL - 165 IS - 6 N2 - 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 ≥10 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/23708168/Liberal_versus_restrictive_transfusion_thresholds_for_patients_with_symptomatic_coronary_artery_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(13)00158-0 DB - PRIME DP - Unbound Medicine ER -