Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis

Wang, Yushu; Shi, Xiuli; Wen, Meiqin; Chen, Yu‐Cheng; Zhang, Qing

doi:10.1080/03007995.2017.1280010

Cited by 11 publications

(11 citation statements)

References 40 publications

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“…We found a reduced risk of myocardial infarction in the liberal transfusion groups, but there was no significant difference in congestive heart failure and arrhythmia between the restrictive and liberal transfusion strategy groups. Wang et al [40] and Docherty et al [16] argued it may not be safe to use a restrictive transfusion strategy in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Another meta-analysis showed there was no significant difference in the incidence of myocardial infarction in patients undergoing hip or knee surgery, but their study included patients who underwent both elective arthroplasty and hip fracture surgery.…”

Section: Discussionmentioning

confidence: 99%

Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients

Zhu¹,

Yin²,

Wang³

et al. 2019

Medicine

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Background: Most clinical guidelines recommend a restrictive red-blood-cell (RBC) transfusion threshold. However, indications for transfusion in patients with a hip fracture have not been definitively evaluated or remain controversial. We compared the pros and cons of restrictive versus liberal transfusion strategies in patients undergoing hip fracture surgery. Methods: Electronic databases were searched to identify randomized controlled trials (RCTs) and retrospective cohort studies (RCSs) to investigate the effects of a restrictive strategy versus its liberal counterpart in patients undergoing hip fracture surgery. The main clinical outcomes included delirium, mortality, infections, cardiogenic complications, thromboembolic events, cerebrovascular accidents, and length of hospital stay. The meta-analysis program of the Cochrane Collaboration (RevMan version 5.3.0) was used for data analysis. Statistical heterogeneity was assessed by both Cochran chi-squared test (Q test) and I 2 test. Both Begg and Egger tests were used to assess potential publication bias. Results: We identified 7 eligible RCTs and 2 eligible RCSs, involving 3,575 patients in total. In patients undergoing hip fracture surgery, we found no differences in frequency of delirium, mortality, the incidence rates of all infections, pneumonia, wound infection, all cardiovascular events, congestive heart failure, thromboembolic events or length of hospital stay between restrictive and liberal thresholds for RBC transfusion ( P >.05). However, we found that the use of restrictive transfusion thresholds is associated with higher rates of acute coronary syndrome ( P <.05) while liberal transfusion thresholds increase the risk of cerebrovascular accidents ( P <.05). Conclusion: In patients undergoing hip fracture surgery, clinicians should evaluate the patient's condition in detail and adopt different transfusion strategies according to the patient's specific situation rather than merely using a certain transfusion strategy.

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Section: Discussionmentioning

confidence: 99%

Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients

Zhu¹,

Yin²,

Wang³

et al. 2019

Medicine

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“…Of these, we excluded 24 studies [9, for the following reasons: seven were abstracts [16,21,22,24,25,27,31], five presented mortality from one trial [28,29,32,33,38], three did not include a meta-analysis [19,26,34], three pooled non-randomised trials [20,35,37], and six were updated by more recent reviews (Additional file 1: Table S4) [9,17,18,23,30,36]. Nineteen systematic reviews provided 33 meta-analyses that satisfied the eligibility criteria of our overview [8,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

Section: Resultsmentioning

confidence: 99%

Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: an overview of systematic reviews

Trentino

Farmer

Leahy

et al. 2020

BMC Med

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Background: There are no overviews of systematic reviews investigating haemoglobin thresholds for transfusion. This is important as the literature on transfusion thresholds has grown considerably in recent years. Our aim was to synthesise evidence from systematic reviews and meta-analyses of the effects of restrictive and liberal transfusion strategies on mortality. Methods: This was a systematic review of systematic reviews (overview). We searched MEDLINE, Embase, Web of Science Core Collection, PubMed, Google Scholar, and the Joanna Briggs Institute EBP Database, from 2008 to 2018. We included systematic reviews and meta-analyses of randomised controlled trials comparing mortality in patients assigned to red cell transfusion strategies based on haemoglobin thresholds. Two independent reviewers extracted data and assessed methodological quality. We assessed the methodological quality of included reviews using AMSTAR 2 and the quality of evidence pooled using an algorithm to assign GRADE levels. Results: We included 19 systematic reviews reporting 33 meta-analyses of mortality outcomes from 53 unique randomised controlled trials. Of the 33 meta-analyses, one was graded as high quality, 15 were moderate, and 17 were low. Of the meta-analyses presenting high-to moderate-quality evidence, 12 (75.0%) reported no statistically significant difference in mortality between restrictive and liberal transfusion groups and four (25.0%) reported significantly lower mortality for patients assigned to a restrictive transfusion strategy. We found few systematic reviews addressed clinical differences between included studies: variation was observed in haemoglobin threshold concentrations, the absolute between group difference in haemoglobin threshold concentration, time to randomisation (resulting in transfusions administered prior to randomisation), and transfusion dosing regimens.

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“…To date, the risks and benefits of optimal transfusion strategy, liberal or restrictive transfusion, remain unclear in such patients. Although several meta-analyses about the transfusion strategies have been published, they did not examine the subgroup of AMI patients with anemia (8)(9)(10). Observational studies have yielded conflicting results (11)(12)(13) and only two previous small randomized clinical trials (RCTs) (including 45 and 110 patients) have compared transfusion strategies in patients with AMI (14,15).…”

Section: Introductionmentioning

confidence: 99%

Restrictive vs. Liberal Red Blood Cell Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: A Systematic Review and Meta-Analysis

Zhang

Huang

et al. 2021

Front. Cardiovasc. Med.

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Objective: Anemia is frequent in patients with acute myocardial infarction (AMI), and the optimal red blood cell transfusion strategy for AMI patients with anemia is still controversial. We aimed to compare the efficacy of restrictive and liberal red cell transfusion strategies in AMI patients with anemia.Methods: We systematically searched PubMed, EMBASE, Web of Science, Cochrane Library, and Clinicaltrials.gov, from their inception until March 2021. Studies designed to compare the efficacy between restrictive and liberal red blood cell transfusion strategies in patients with AMI were included. The primary outcome was all-cause mortality, including overall mortality, in-hospital or follow-up mortality. Risk ratios (RR) with 95% confidence intervals (CI) were presented and pooled by random-effects models.Results: The search yielded a total of 6,630 participants in six studies. A total of 2,008 patients received restrictive red blood cell transfusion while 4,622 patients were given liberal red blood cell transfusion. No difference was found in overall mortality and follow-up mortality between restrictive and liberal transfusion groups (RR = 1.07, 95% CI = 0.82–1.40, P = 0.62; RR = 0.89, 95% CI = 0.56–1.42, P = 0.62). However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion (RR = 1.22, 95% CI = 1.00–1.50, P = 0.05). No secondary outcomes, including follow-up reinfarction, stroke, and acute heart failure, differed significantly between the two groups. In addition, subgroup analysis showed no differences in overall mortality between the two groups based on sample size and design.Conclusion: Restrictive and liberal red blood cell transfusion have a similar effect on overall mortality and follow-up mortality in AMI patients with anemia. However, restrictive transfusion tended to have a higher risk of in-hospital mortality compared with liberal transfusion. The findings suggest that transfusion strategy should be further evaluated in future studies.

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Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis

Cited by 11 publications

References 40 publications

Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients

Restrictive versus liberal strategy for red blood-cell transfusion in hip fracture patients

Systematic reviews and meta-analyses comparing mortality in restrictive and liberal haemoglobin thresholds for red cell transfusion: an overview of systematic reviews

Restrictive vs. Liberal Red Blood Cell Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: A Systematic Review and Meta-Analysis

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