Aneurysmal SubArachnoid Hemorrhage-Red Blood Cell Transfusion And Outcome (SAHaRA): a pilot randomised controlled...

Area of Science:

• Neurology
• Critical Care Medicine
• Hematology

Background:

• Anemia is prevalent in aneurysmal subarachnoid hemorrhage (aSAH) and may worsen secondary injury.
• Current transfusion practices for aSAH patients with anemia are often restrictive, despite guidelines suggesting higher hemoglobin levels.
• The optimal red blood cell (RBC) transfusion strategy for anemic aSAH patients remains unclear.

Purpose of the Study:

• To determine the feasibility of conducting a multicenter pilot trial on RBC transfusion strategies in acute aSAH.
• To compare a liberal RBC transfusion strategy (Hb ≤100 g/L) against a restrictive strategy (Hb ≤80 g/L).
• To evaluate the impact of transfusion strategies on the combined rate of death and severe disability at 12 months.

Main Methods:

• A multicenter, open-label, randomized controlled pilot trial involving 5 academic tertiary care centers.
• Adult aSAH patients with anemia (Hb ≤110 g/L) within 14 days of initial bleed were targeted.
• Patients were randomized to a liberal (Hb ≤100 g/L) or restrictive (Hb ≤80 g/L) transfusion strategy when Hb fell to ≤100 g/L.

Main Results:

• The primary outcome was the feasibility of the randomization rate across centers.
• Secondary outcomes included transfusion threshold adherence, protocol adherence, and clinical outcomes (mortality, modified Rankin Score, etc.).
• This is a pre-results study; detailed findings on feasibility and patient outcomes are pending.

Conclusions:

• This pilot trial is designed to assess the feasibility of a larger pragmatic randomized controlled trial.
• The findings will inform the design and execution of future studies comparing liberal versus restrictive RBC transfusion strategies in aSAH.
• Establishing feasibility is crucial for advancing evidence-based transfusion management in aSAH patients.