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


Journal Article

BACKGROUND: 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. METHODS: We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 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 hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. RESULTS: 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). CONCLUSIONS: 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.

Full Text

Duke Authors

Cited Authors

  • Carson, JL; Brooks, MM; Abbott, JD; Chaitman, B; Kelsey, SF; Triulzi, DJ; Srinivas, V; Menegus, MA; Marroquin, OC; Rao, SV; Noveck, H; Passano, E; Hardison, RM; Smitherman, T; Vagaonescu, T; Wimmer, NJ; Williams, DO

Published Date

  • June 2013

Published In

Volume / Issue

  • 165 / 6

Start / End Page

  • 964 - 971.e1

PubMed ID

  • 23708168

Pubmed Central ID

  • 23708168

Electronic International Standard Serial Number (EISSN)

  • 1097-6744

Digital Object Identifier (DOI)

  • 10.1016/j.ahj.2013.03.001


  • eng

Conference Location

  • United States