Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage

Area of Science:

• Neurology
• Critical Care Medicine
• Hematology

Background:

• The optimal red-cell transfusion strategy for patients with aneurysmal subarachnoid hemorrhage (aSAH) experiencing anemia remains unclear.
• This study addresses the uncertainty surrounding liberal versus restrictive transfusion protocols during the critical care period post-aSAH.

Purpose of the Study:

• To compare the effectiveness of a liberal red-cell transfusion strategy against a restrictive strategy in critically ill patients with aSAH and anemia.
• To evaluate the impact of transfusion strategies on neurologic outcomes, functional independence, and quality of life at 12 months.

Main Methods:

• Randomized controlled trial involving critically ill adults with acute aSAH and anemia.
• Patients were assigned to either a liberal transfusion strategy (hemoglobin ≤10 g/dL) or a restrictive strategy (hemoglobin ≤8 g/dL).
• Primary outcome was unfavorable neurologic outcome (modified Rankin Scale ≥4) at 12 months; secondary outcomes included functional independence (FIM) and quality of life (EQ-5D-5L, VAS).

Main Results:

• No significant difference in unfavorable neurologic outcomes at 12 months between the liberal (33.5%) and restrictive (37.7%) groups (Risk Ratio 0.88; 95% CI, 0.72 to 1.09; P=0.22).
• Similar mean scores for functional independence (FIM) and quality of life (EQ-5D-5L, VAS) were observed in both groups.
• The incidence of adverse events was comparable between the liberal and restrictive transfusion strategy groups.

Conclusions:

• A liberal red-cell transfusion strategy does not lead to better neurologic outcomes compared to a restrictive strategy in patients with aneurysmal subarachnoid hemorrhage and anemia.
• Transfusion thresholds of ≤10 g/dL versus ≤8 g/dL did not significantly impact 12-month functional or quality-of-life outcomes in this patient population.