Mo1187 - Restrictive vs. Liberal Transfusions Strategy in Patients with Upper Gastrointestinal Bleeding — a Randomized Controlled Trial

Kate, Vikram; Kola, G.; Mohsina, Subair; Sureshkumar, Sathasivam; Sreenath, G

doi:10.1016/s0016-5085(18)32468-5

Cited by 2 publications

(2 citation statements)

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“…A randomised trial in patients with UGIB because of variceal or nonvariceal causes showed that a restrictive transfusion strategy (threshold of 7 g dl −1 ) did not increase mortality, morbidity or re-bleeding rates nor the need for interventions when compared with a liberal transfusion strategy (threshold of 8 g dl −1 ) 730 . A large multicentre, cluster randomised feasibility study showed similar outcomes (re-bleeding and 28-day mortality) when a restrictive transfusion strategy (trigger Hb 8 g dl −1 ) was compared with a liberal transfusion strategy (trigger Hb 10 g dl −1 ) in patients with UGIB 731 .…”

Section: Discussionmentioning

confidence: 99%

“…693,729 Transfusion strategy and pharmacological interventions A randomised trial in patients with UGIB because of variceal or nonvariceal causes showed that a restrictive transfusion strategy (threshold of 7 g dl À1 ) did not increase mortality, morbidity or re-bleeding rates nor the need for interventions when compared with a liberal transfusion strategy (threshold of 8 g dl À1 ). 730 A large multicentre, cluster randomised feasibility study showed similar outcomes (re-bleeding and 28-day mortality) when a restrictive transfusion strategy (trigger Hb 8 g dl À1 ) was compared with a liberal transfusion strategy (trigger Hb 10 g dl À1 ) in patients with UGIB. 731 Recently, published guidelines recommend a restrictive policy of RBC transfusion with a threshold for transfusion of Hb 7 g dl À1 for patients with UGIB, 8 g dl À1 in patients with preexisting cardiovascular disease while a threshold higher than 8 g dl À1 may be considered in patients with UGIB and ACS, based on very limited evidence in this patient category.…”

Section: Variceal Bleedingmentioning

confidence: 99%

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Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

103

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BACKGROUND Management of peri-operative bleeding is complex and involves multiple assessment tools and strategies to ensure optimal patient care with the goal of reducing morbidity and mortality. These updated guidelines from the European Society of Anaesthesiology and Intensive Care (ESAIC) aim to provide an evidence-based set of recommendations for healthcare professionals to help ensure improved clinical management. DESIGN A systematic literature search from 2015 to 2021 of several electronic databases was performed without language restrictions. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assess the methodological quality of the included studies and to formulate recommendations. A Delphi methodology was used to prepare a clinical practice guideline. RESULTS These searches identified 137 999 articles. All articles were assessed, and the existing 2017 guidelines were revised to incorporate new evidence. Sixteen recommendations derived from the systematic literature search, and four clinical guidances retained from previous ESAIC guidelines were formulated. Using the Delphi process on 253 sentences of guidance, strong consensus (>90% agreement) was achieved in 97% and consensus (75 to 90% agreement) in 3%. DISCUSSION Peri-operative bleeding management encompasses the patient's journey from the pre-operative state through the postoperative period. Along this journey, many features of the patient's pre-operative coagulation status, underlying comorbidities, general health and the procedures that they are undergoing need to be taken into account. Due to the many important aspects in peri-operative nontrauma bleeding management, guidance as to how best approach and treat each individual patient are key. Understanding which therapeutic approaches are most valuable at each timepoint can only enhance patient care, ensuring the best outcomes by reducing blood loss and, therefore, overall morbidity and mortality. CONCLUSION All healthcare professionals involved in the management of patients at risk for surgical bleeding should be aware of the current therapeutic options and approaches that are available to them. These guidelines aim to provide specific guidance for bleeding management in a variety of clinical situations.

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Section: Discussionmentioning

confidence: 99%

Section: Variceal Bleedingmentioning

confidence: 99%

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Kietaibl

Ahmed

Afshari

et al. 2023

European Journal of Anaesthesiology

103

View full text Add to dashboard Cite

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Potential benefits of restrictive transfusion in upper gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials

Teutsch,

Veres,

Pálinkás

et al. 2023

Sci Rep

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The optimal red blood cell (RBC) transfusion strategy in acute gastrointestinal bleeding (GIB) is debated. We aimed to assess the efficacy and safety of restrictive compared to liberal transfusion strategies in the GIB population. We searched PubMed, CENTRAL, Embase, and Web of Science for randomised controlled trials on 15.01.2022 without restrictions. Studies comparing lower to higher RBC transfusion thresholds after GIB were eligible. We used the random effect model and calculated pooled mean differences (MD), risk ratios (RR) and proportions with 95% confidence intervals (CI) to calculate the overall effect size. The search yielded 3955 hits. All seven eligible studies reported on the upper GIB population. Restrictive transfusion did not increase the in-hospital- (RR: 0.94; CI 0.46, 1.94) and 30-day mortality (RR: 0.71; CI 0.35, 1.45). In-hospital- and 28 to 45-day rebleeding rate was also not higher with the restrictive modality (RR: 0.67; CI 0.30, 1.50; RR:0.75; CI 0.49, 1.16, respectively). Results of individual studies showed a lower rate of transfusion reactions and post-transfusion intervention if the transfusion was started at a lower threshold. A haemoglobin threshold > 80 g/L may result in a higher untoward outcome rate. In summary, restrictive transfusion does not appear to lead to a higher rate of significant clinical endpoints. The optimal restrictive transfusion threshold should be further investigated.

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Mo1187 - Restrictive vs. Liberal Transfusions Strategy in Patients with Upper Gastrointestinal Bleeding — a Randomized Controlled Trial

Cited by 2 publications

References 0 publications

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

Potential benefits of restrictive transfusion in upper gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials

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