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Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis.
Curr Med Res Opin. 2017 04; 33(4):761-768.CM

Abstract

OBJECTIVES

To compare clinical outcomes between restrictive versus liberal blood transfusion strategies in patients with coronary artery disease (CAD).

RESEARCH DESIGN AND METHODS

A literature search from January 1966 to May 2016 was performed in PubMed, EMBASE and Cochrane Library to find trials evaluating a restrictive hemoglobin transfusion trigger of ≤8 g/dL, compared with a more liberal trigger. Two study authors independently extracted data from the trials. The primary outcome was mortality and the secondary outcome was subsequent myocardial infarction. Relative risks (RRs) with their 95% confidence intervals (CIs) were assessed.

RESULTS

Six trials involving 133,058 participants were included in this study. Pooled results revealed no difference in mortality between the liberal transfusion and restrictive transfusions (RR = 1.17, 95% CI = 0.91-1.52, P = .22). Subgroup analysis revealed that a restrictive transfusion strategy was associated with a higher risk of in-hospital mortality (RR = 1.38, 95% CI = 1.15-1.67, P < .001) and 30 day mortality (RR = 1.21, 95% CI = 1.01-1.45, P = .03), compared with the liberal strategy. No significant difference was found between the liberal transfusion strategy and restrictive transfusion strategy in risk for subsequent myocardial infarction (RR = 1.09, 95% CI = 0.57-2.06, P = .80).

LIMITATIONS

Limitations include (1) limited number of trials, especially those evaluating myocardial infarction, (2) observed heterogeneity, (3) confounding by indication and other inherent bias may exist.

CONCLUSION

The findings suggest that restrictive blood transfusion was associated with higher in-hospital and 30 day mortality than liberal blood transfusion in CAD patients. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by randomized controlled trials.

Authors+Show Affiliations

a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28067544

Citation

Wang, Yushu, et al. "Restrictive Versus Liberal Blood Transfusion in Patients With Coronary Artery Disease: a Meta-analysis." Current Medical Research and Opinion, vol. 33, no. 4, 2017, pp. 761-768.
Wang Y, Shi X, Wen M, et al. Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis. Curr Med Res Opin. 2017;33(4):761-768.
Wang, Y., Shi, X., Wen, M., Chen, Y., & Zhang, Q. (2017). Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis. Current Medical Research and Opinion, 33(4), 761-768. https://doi.org/10.1080/03007995.2017.1280010
Wang Y, et al. Restrictive Versus Liberal Blood Transfusion in Patients With Coronary Artery Disease: a Meta-analysis. Curr Med Res Opin. 2017;33(4):761-768. PubMed PMID: 28067544.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis. AU - Wang,Yushu, AU - Shi,Xiuli, AU - Wen,Meiqin, AU - Chen,Yucheng, AU - Zhang,Qing, Y1 - 2017/02/03/ PY - 2017/1/10/pubmed PY - 2017/9/1/medline PY - 2017/1/10/entrez KW - Coronary artery disease KW - liberal transfusion KW - mortality KW - red blood cell transfusion KW - restrictive transfusion SP - 761 EP - 768 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 33 IS - 4 N2 - OBJECTIVES: To compare clinical outcomes between restrictive versus liberal blood transfusion strategies in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS: A literature search from January 1966 to May 2016 was performed in PubMed, EMBASE and Cochrane Library to find trials evaluating a restrictive hemoglobin transfusion trigger of ≤8 g/dL, compared with a more liberal trigger. Two study authors independently extracted data from the trials. The primary outcome was mortality and the secondary outcome was subsequent myocardial infarction. Relative risks (RRs) with their 95% confidence intervals (CIs) were assessed. RESULTS: Six trials involving 133,058 participants were included in this study. Pooled results revealed no difference in mortality between the liberal transfusion and restrictive transfusions (RR = 1.17, 95% CI = 0.91-1.52, P = .22). Subgroup analysis revealed that a restrictive transfusion strategy was associated with a higher risk of in-hospital mortality (RR = 1.38, 95% CI = 1.15-1.67, P < .001) and 30 day mortality (RR = 1.21, 95% CI = 1.01-1.45, P = .03), compared with the liberal strategy. No significant difference was found between the liberal transfusion strategy and restrictive transfusion strategy in risk for subsequent myocardial infarction (RR = 1.09, 95% CI = 0.57-2.06, P = .80). LIMITATIONS: Limitations include (1) limited number of trials, especially those evaluating myocardial infarction, (2) observed heterogeneity, (3) confounding by indication and other inherent bias may exist. CONCLUSION: The findings suggest that restrictive blood transfusion was associated with higher in-hospital and 30 day mortality than liberal blood transfusion in CAD patients. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by randomized controlled trials. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/28067544/Restrictive_versus_liberal_blood_transfusion_in_patients_with_coronary_artery_disease:_a_meta_analysis_ L2 - https://www.tandfonline.com/doi/full/10.1080/03007995.2017.1280010 DB - PRIME DP - Unbound Medicine ER -