Restrictive versus Liberal Transfusion Thresholds

CA-2 · II.D.2.f.6 I.C.2.a.5.a

31Sources
6Kept
1Dropped

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31 candidate papers

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7 points

Pooling 4,311 patients including MINT, restrictive transfusion in myocardial infarction gave more cardiac death at 30 days (5.5% versus 3.7%) and higher all-cause mortality at 6 months. PMID 39714935 kept
In FOCUS, a 10 g/dL threshold after hip fracture surgery in patients at cardiovascular risk gave no better survival or independent walking at 60 days than transfusing at 8 g/dL or for symptoms. PMID 22168590 kept
Across 13 cardiac surgery trials and 9,092 patients, a restrictive threshold was not inferior to a liberal one for 30-day mortality, myocardial infarction, stroke, renal failure or infection. PMID 30107514 — not confirmed against the abstract: The abstract mentions 13 trials and 4545+4547=9092 patients assigned to restrictive vs liberal strategies, but the sentence states "Across 13 cardiac surgery trials and 9,092 patients". Also, the abstract does not explicitly state that a restrictive threshold was *not inferior* (it says the evidence doesn't support the notion it is inferior), nor does dropped
In TRICC, transfusing at a haemoglobin below 7 g/dL was at least as effective as below 10 g/dL in critically ill patients, with lower in-hospital mortality and the possible exception of acute myocardial infarction and unstable angina. PMID 9971864 kept
Transfusing patients whose oxygen extraction ratio exceeded 0.30 improved that ratio and central venous oxygen saturation, while those at or below 0.30 gained no physiological benefit. PMID 40134137 kept
Haemoglobin alone does not reflect tissue oxygenation, and a single threshold across an ICU stay prevents neither unnecessary nor insufficient transfusion; central venous oxygen saturation and oxygen extraction ratio are bedside alternatives under study. PMID 41586889 kept
For hospitalised patients with acute myocardial infarction the AABB guideline suggests a liberal strategy below 10 g/dL, noting a restrictive 7-8 g/dL threshold may increase mortality in this group. PMID 40825204 kept

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