Effect of Restrictive or Liberal Blood Transfusion on Major Cardiovascular Events in Patients With Acute Myocardial Infarction and Anemia—Reply

Abstract

In Reply Dr Phillips correctly points out that we did not include leg length inequality as a biomechanical risk factor for hip and knee osteoarthritis in our review. 1 We regret the omission. Indeed, analyses conducted with data from the Multicenter Osteoarthritis Study, Osteoarthritis Initiative, and Johnston County Osteoarthritis Project showed that leg length inequality of 1 cm or greater was associated with a higher incidence of knee and hip osteoarthritis in the shorter limb, adjusting for age, sex, and body mass index. [2][3][4] When a threshold of 2 cm or greater was used to define leg length inequality, the risks of knee and hip osteoarthritis were even higher. For example, in 1 study, the odds of incident symptomatic knee osteoarthritis in the shorter leg of people with leg length inequality of 1 cm or greater were 1.7fold higher than in those without leg length inequality. 2 In this study, the odds ratio doubled to 4.1 for leg length inequality of 2 cm or greater.Phillips speculates that use of an orthotic insert for the shorter limb may reduce the risk of knee or hip osteoarthritis. This hypothesis has been examined in small clinical studies, mostly for low back pain. 5 Currently, there is insufficient evidence to recommend routine use of orthotic inserts for prevention or treatment of knee or hip osteoarthritis in persons with leg length inequality. We also note that because altered joint tissue metabolism can be driven by biomechanical factors, it is unlikely that leg length inequality would cause osteoarthritis only by simple "wear and tear," as suggested by Phillips.

2021: Perioperative and critical care year in review for the cardiothoracic surgery team

“… 7 , 8 We also revisit the perennial equipoise that underpins blood product transfusion thresholds. 9 , 10 In a similar but separate vein, we conclude with a report on the comparison of different choices of resuscitative intravenous fluids, a decades-long dispute that as yet remained unresolved. 4 , 11…”

“…It was a large-scale, open-label, multicentric randomized trial designed to determine whether a restrictive transfusion strategy was clinically noninferior to a liberal transfusion strategy. 10 It enrolled 668 patients with AMI and hemoglobin levels between 7 and 10 g/dL who were randomized to either a restrictive or liberal transfusion strategy with a threshold for transfusion set at a hemoglobin level <8 or <10 g/dL, respectively. The primary composite outcome (all-cause death, stroke, recurrent myocardial infarction, or emergency revascularization) at 30 days occurred in 11% versus 14% of patients, a difference that met the noninferiority criterion.…”

Comparison between Machine Learning and Multiple Linear Regression to Identify Abnormal Thallium Myocardial Perfusion Scan in Chinese Type 2 Diabetes

“…Anemia could alter ST-segment changes [ 59 ]; 3. Different methods of transfusion could have different impacts on the prognosis of MI [ 60 ]. Among these studies, Cook et al performed a study to show the precise impact of anemia on MPS.…”