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

Carson, Jeffrey L.; Brooks, Maria M.; Abbott, J. Dawn; Chaitman, Bernard R.; Kelsey, Sheryl F.; Triulzi, Darrell J.; Srinivas, Vankeepuram S.; Menegus, Mark; Marroquin, Oscar C.; Rao, Sunil V.; Noveck, Helaine; Passano, Elizabeth; Hardison, Regina M.; Smitherman, Thomas C.; Vagaonescu, Tudor; Wimmer, Neil J.; Williams, David O.

doi:10.1016/j.ahj.2013.03.001

Cited by 316 publications

(245 citation statements)

References 18 publications

(18 reference statements)

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“…14 In the MINT (Myocardial Infarction and Transfusion) trial in 110 patients, there was a trend toward fewer major cardiac events and deaths in the liberal group (7 deaths in the restrictive group and 1 death in the liberal group; P ϭ .03). 15 Combining the 2 trials in acute coronary syndrome, there were 9 deaths in the restrictive group and 2 deaths in the liberal group. These trials are the first to signal that liberal trsfusion might be superior to rerictive transfusion in the setting of acute coronary syndrome.…”

Section: Other Smaller Trialsmentioning

confidence: 99%

Transfusion strategies in hematologic and nonhematologic disease

Carson

Strair

2014

Hematology

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Substantial progress has been made in our understanding of the risks and benefits of RBC transfusion through the performance of large clinical trials. More than 7000 patients have been enrolled in trials randomly allocating patients to higher transfusion thresholds (ϳ9-10 g/dL), referred to as liberal transfusion, or lower transfusion thresholds (ϳ7-8 g/dL), referred to as restrictive transfusion. The results of most of the trials suggest that a restrictive transfusion strategy is safe and, in some cases, superior to a liberal transfusion strategy. However, in patients with myocardial infarction, brain injury, stroke, or hematological disorders, more large trials are needed because preliminary evidence suggests that liberal transfusion might be beneficial or trials have not been performed at all. Learning Objective• To understand the clinical trial evidence that has evaluated the effect of blood transfusion on mortality and morbidity

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Section: Other Smaller Trialsmentioning

confidence: 99%

Transfusion strategies in hematologic and nonhematologic disease

Carson

Strair

2014

Hematology

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“…A fall in Hg increases the risk of ischemia with ensuing negative outcomes. 32 For cardiac surgical patients, Murphy et al 33 did not find a difference in the occurrence of severe infections, myocardial infarction, mesenteric infarction, or acute kidney injury between a liberal and restrictive strategy (33 vs. 35.1%; OR, 1.11; 95% CI, 0.91-1.34; p ¼ 0.30). However, the mortality rate was higher in the restrictive group compared with the liberal group (4.2% vs. 2.6%; HR, 1.64; 95% CI, 1-2.67; p ¼ 0.045).…”

Section: Transfusion Thresholdsmentioning

confidence: 99%

Untitled

2017

Int J Angiol

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“…In those patients with co-existing cardiac disease, the refusal of blood products was associated with an increased risk of death. 17 A randomized pilot trial of 110 anemic patients with acute coronary syndrome or stable angina undergoing cardiac catheterization revealed greater than twice the risk of myocardial infarction, unscheduled revascularization, or death within 30 days when treated with a restrictive (transfusion for symptomatic anemia or Hbg <8 g/dl) transfusion protocol 18 . However, recent registry data further obfuscates the decision whether or not to transfuse these patients; data have shown an increased risk of cardiovascular morbidity with as little as one unit of red blood cell transfusion during the perioperative period 19 .…”

Section: Anemia Of Chronic Diseasementioning

confidence: 99%