Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
Carson, Jeffrey L. MD a,*; Brooks, Maria Mori PhD b; Abbott, Dawn J. MD c; Chaitman, Bernard MD d; Kelsey, Sheryl F. PhD b; Triulzi, Darrell J. MD e; Srinivas, Vankeepuram MD f; Menegus, Mark A. MD f; Marroquin, Oscar C. MD g; Rao, Sunil V. MD h; Noveck, Helaine MPH a; Passano, Elizabeth MS b; Hardison, Regina M. MS b; Smitherman, Thomas MD g; Vagaonescu, Tudor MD i; Wimmer, Neil J. MD j; Williams, David O. MD j
[Article]
American Heart Journal.
165(6):964-971e1, June 2013.
(Format: HTML, PDF)
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.
(C) 2013Elsevier, Inc.