Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial.

Area of Science:

• Neurology
• Critical Care Medicine
• Hematology

Background:

• Blood transfusions are common in acute brain injury (ABI) patients.
• Optimal hemoglobin transfusion thresholds for ABI remain uncertain.
• Anemia management is critical for neurological recovery.

Purpose of the Study:

• To compare the neurological outcomes of two hemoglobin thresholds for red blood cell transfusions in ABI patients.
• To determine if a liberal or restrictive transfusion strategy impacts patient recovery.
• To evaluate the safety and efficacy of different transfusion triggers.

Main Methods:

• A multicenter, open-label, randomized clinical trial involving 850 ABI patients.
• Patients were assigned to either a liberal (hemoglobin <9 g/dL) or restrictive (hemoglobin <7 g/dL) transfusion strategy.
• The primary outcome was unfavorable neurological outcome at 180 days, assessed by the Glasgow Outcome Scale Extended.

Main Results:

• The liberal strategy group showed a lower rate of unfavorable neurological outcomes (62.6%) compared to the restrictive group (72.6%) at 180 days (absolute difference, -10.0%).
• Patients receiving the liberal strategy had a reduced risk of cerebral ischemic events (8.8% vs 13.5%).
• The liberal strategy involved a median of 2 units of blood transfused versus 0 in the restrictive group.

Conclusions:

• A liberal red blood cell transfusion strategy is associated with improved neurological outcomes in patients with acute brain injury.
• The findings suggest that maintaining higher hemoglobin levels may be beneficial for recovery in this population.
• This study provides critical evidence for guiding transfusion practices in critical care settings.