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Updated: Sep 19, 2025
Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury
Published on: May 27, 2022
Liberal vs. restrictive transfusion strategy for acute brain injury: A meta-analysis with trial sequential analysis
Wen-Wen Tsai1, Jheng-Yan Wu2, Kuan-Hsien Lu1
1Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.
Background:
Acute brain injury is a critical health challenge with substantial mortality and morbidity. While anemia is common in these patients and may worsen outcomes, the optimal red blood cell transfusion strategy remains controversial.
Objective:
We conducted a meta-analysis with trial sequential analysis of randomized controlled trials (RCTs) comparing liberal versus restrictive transfusion strategies in patients with acute brain injury.
Methods:
Pubmed, Embase, and the Cochrane Library databases were searched through December 15, 2024, for RCT comparing liberal (hemoglobin threshold 9-10 g/dL) versus restrictive (hemoglobin threshold 7-8 g/dL) transfusion strategies in adults with acute brain injury. The primary outcome was an unfavorable neurological outcome.
Results:
Six RCTs involving 2599 patients were included. There was no significant difference in unfavorable neurological outcomes between liberal and restrictive strategies (risk ratio [RR], 0.97; 95% confidence interval [CI], 0.83-1.14; p = 0.70). Similarly, no differences were observed in overall mortality (RR, 0.98; 95% CI, 0.85-1.12; p = 0.75), hospital mortality (RR, 1.02; 95% CI, 0.79-1.31; p = 0.89), or intensive care unit (ICU) mortality (RR, 0.74; 95% CI, 0.28-1.91; p = 0.53). Although transfusion reaction was non-significantly more frequent with liberal transfusion (RR, 1.13; 95% CI, 0.35-3.58; p = 0.84).
Conclusions:
In patients with acute brain injury, a restrictive transfusion strategy was not associated with worse neurological outcomes or higher mortality compared to a liberal strategy.
Implications For Clinical Practice:
Maintaining hemoglobin levels above 7-8 g/dL may be effective for patients with acute brain injury, potentially reducing unnecessary transfusions and associated risks. META-ANALYSIS REGISTRATION: registered on PROSPERO under number CRD42025639745.
