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Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease
- Source :
- American heart journal. 165(6)
- Publication Year :
- 2012
-
Abstract
- 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.We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin10 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 hemoglobin8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization.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).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.
- Subjects :
- Acute coronary syndrome
medicine.medical_specialty
Cardiac Catheterization
Blood transfusion
medicine.medical_treatment
Decision Making
Pilot Projects
Coronary Artery Disease
Article
law.invention
Coronary artery disease
Electrocardiography
Hemoglobins
Randomized controlled trial
law
Internal medicine
medicine
Humans
Blood Transfusion
Survival rate
Cardiac catheterization
Retrospective Studies
business.industry
Incidence
Retrospective cohort study
medicine.disease
Prognosis
Confidence interval
United States
Survival Rate
Death, Sudden, Cardiac
Cardiology
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 10976744
- Volume :
- 165
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- American heart journal
- Accession number :
- edsair.doi.dedup.....f974d8b87b880ba96e79760c7fdcc7c1