Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia

Year: 2023

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: BACKGROUND: A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. METHODS: In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. RESULTS: A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). CONCLUSIONS: In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.).

Source: New England Journal of Medicine

DOI: 10.1056/nejmoa2307983

Institutions: Rutgers, The State University of New Jersey, St. Michael's Hospital, University of Ottawa, University of Alberta, University of Pittsburgh, University of Toronto, Centre Hospitalier de l’Université de Montréal, Ottawa Hospital Research Institute, Bruyère, Université de Montréal, Canadian VIGOUR Centre, National Heart, Lung, and Blood Institute, Saint Louis University, Sorbonne Université, Hôpital Saint-Antoine, Duke University, Duke Clinical Research Institute, Baystate Medical Center, Baystate Health, University of Nebraska Medical Center, Vanderbilt University Medical Center, Brown University, Lifespan, NYU Langone Health, New York University, Westchester Medical Center, University of Louisville, AdventHealth, Inserm, Université Paris Cité, Assistance Publique – Hôpitaux de Paris, Laboratoire de Recherche Vasculaire Translationnelle, Hôpital Bichat-Claude-Bernard, Montefiore Medical Center, McMaster University, University of British Columbia, Vancouver General Hospital, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, Pitié-Salpêtrière Hospital, WakeMed, Université de Sherbrooke, University of Chicago, University of Chicago Medical Center, Grey Nuns Community Hospital, Hôpital Européen Georges-Pompidou, Centre Hospitalier Universitaire de Nîmes

Language: English

Topic: Blood transfusion and management

Subfield: Biochemistry

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: green

Funders: Canadian Blood Services, Agence Nationale de la Recherche, Canadian Institutes of Health Research, National Heart, Lung, and Blood Institute, Institute of Circulatory and Respiratory Health

Awards: G122424666, iMAP, G1399038516, iVASC

OpenAlex ID: W4388591663