Restrictive versus liberal transfusion strategy in upper gastrointestinal bleeding: A randomized controlled trial

Area of Science:

• Gastroenterology
• Hematology
• Critical Care Medicine

Background:

• Upper gastrointestinal bleeding (UGIB) management often involves red blood cell transfusions.
• The optimal hemoglobin threshold for transfusion in UGIB remains debated.
• Comparing restrictive versus liberal transfusion strategies is crucial for patient outcomes.

Purpose of the Study:

• To compare the efficacy of restrictive versus liberal transfusion strategies in reducing mortality in patients with UGIB.
• To evaluate secondary outcomes including morbidity, re-bleeding, and need for intervention.

Main Methods:

• A single-center, prospective, open-label, non-inferiority randomized controlled trial was conducted.
• 224 patients with UGIB were randomized into restrictive (hemoglobin <7 g/dl) or liberal (hemoglobin <8 g/dl) transfusion groups.
• Primary outcome was 45-day mortality; secondary outcomes included morbidity and re-bleeding.

Main Results:

• 45-day mortality was similar between restrictive and liberal groups (10/112 vs. 12/112; P=0.65).
• Secondary outcomes such as in-hospital bleeding, re-bleeding, need for endoscopic banding, and hospital stay were also comparable.
• Demographic characteristics of the 224 randomized patients were similar between groups.

Conclusions:

• A restrictive transfusion strategy is non-inferior to a liberal strategy in patients with UGIB.
• These findings suggest that a less aggressive transfusion approach is safe and effective for UGIB management.
• The study supports current guidelines recommending restrictive transfusion in UGIB.