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Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis
Yushu Wang1, Xiuli Shi1, Meiqin Wen1
1a Department of Cardiology , West China Hospital, Sichuan University , Chengdu , Sichuan , China.
Insights
Restrictive blood transfusion strategies in patients with coronary artery disease (CAD) were associated with higher in-hospital and 30-day mortality compared to liberal strategies. Further randomized controlled trials are needed to confirm these findings.
Area of Science:
- Cardiology
- Transfusion Medicine
- Clinical Outcomes Research
Background:
- Blood transfusion strategies vary for patients with coronary artery disease (CAD).
- Restrictive transfusion targets (hemoglobin ≤8 g/dL) are often compared to liberal approaches.
- Clinical outcomes, including mortality and myocardial infarction, require careful evaluation.
Purpose of the Study:
- To compare clinical outcomes between restrictive and liberal blood transfusion strategies in patients with CAD.
- To assess the impact of transfusion strategies on mortality and myocardial infarction.
- To synthesize evidence from existing trials on transfusion practices in CAD.
Main Methods:
- A comprehensive literature search was conducted across PubMed, EMBASE, and Cochrane Library.
- Trials comparing restrictive (≤8 g/dL hemoglobin) versus liberal transfusion triggers were identified.
- Data extraction and assessment of relative risks (RRs) with 95% confidence intervals (CIs) were performed.
Main Results:
- Six trials with 133,058 participants were analyzed.
- No significant difference in overall mortality was observed between liberal and restrictive strategies (RR=1.17, 95% CI=0.91-1.52).
- Restrictive transfusion was linked to increased in-hospital (RR=1.38, 95% CI=1.15-1.67) and 30-day mortality (RR=1.21, 95% CI=1.01-1.45).
- No significant difference in subsequent myocardial infarction risk was found (RR=1.09, 95% CI=0.57-2.06).
Conclusions:
- Restrictive blood transfusion in CAD patients may be associated with higher in-hospital and 30-day mortality.
- These findings are primarily based on retrospective data.
- Randomized controlled trials are necessary to validate these conclusions and guide clinical recommendations.
Objectives:
To compare clinical outcomes between restrictive versus liberal blood transfusion strategies in patients with coronary artery disease (CAD).
Research Design And Methods:
A literature search from January 1966 to May 2016 was performed in PubMed, EMBASE and Cochrane Library to find trials evaluating a restrictive hemoglobin transfusion trigger of ≤8 g/dL, compared with a more liberal trigger. Two study authors independently extracted data from the trials. The primary outcome was mortality and the secondary outcome was subsequent myocardial infarction. Relative risks (RRs) with their 95% confidence intervals (CIs) were assessed.
Results:
Six trials involving 133,058 participants were included in this study. Pooled results revealed no difference in mortality between the liberal transfusion and restrictive transfusions (RR = 1.17, 95% CI = 0.91-1.52, P = .22). Subgroup analysis revealed that a restrictive transfusion strategy was associated with a higher risk of in-hospital mortality (RR = 1.38, 95% CI = 1.15-1.67, P < .001) and 30 day mortality (RR = 1.21, 95% CI = 1.01-1.45, P = .03), compared with the liberal strategy. No significant difference was found between the liberal transfusion strategy and restrictive transfusion strategy in risk for subsequent myocardial infarction (RR = 1.09, 95% CI = 0.57-2.06, P = .80).
Limitations:
Limitations include (1) limited number of trials, especially those evaluating myocardial infarction, (2) observed heterogeneity, (3) confounding by indication and other inherent bias may exist.
Conclusion:
The findings suggest that restrictive blood transfusion was associated with higher in-hospital and 30 day mortality than liberal blood transfusion in CAD patients. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by randomized controlled trials.
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