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Transfusion-related adverse events in patients with restrictive or liberal transfusion strategy. An analysis of the
Shahab Ghafghazi1, Lynne Uhl2,3, Brandon Herbert4,5,6
1Department of Medicine, Division of Cardiology, University of Louisville, Louisville, Kentucky, USA.
Background:
The aim of this analysis was to quantify and compare the frequency of transfusion-related adverse events (TRAE) in adult patients with myocardial infarction transfused with a restrictive versus liberal transfusion strategy from the Myocardial Ischemia and Transfusion (MINT) trial.
Study Design And Methods:
Clinical sites reported TRAE. Major TRAE were transfusion-related acute lung injury, transfusion-associated circulatory overload, acute hemolytic transfusion reaction, anaphylactic transfusion reaction, and transfusion-associated sepsis. TRAE rates per transfusion arm per patient and per 100 units of red blood cells (RBC) transfused were calculated.
Results:
There were nine site-reported events in the restrictive transfusion arm and 49 events in the liberal transfusion arm with an overall event rate of 0.51 in the restrictive transfusion arm, and 2.80 in the liberal transfusion arm per 100 patients, rate difference -2.29; 95% confidence interval [CI], -3.12,-1.44.. The rate of major TRAE was 0.51 in the restrictive arm and 1.99 in the liberal arm per 100 patients, rate difference -1.48 (95% CI, -2.21, -0.74). When the rates were normalized per 100 units of RBC transfused, the rate difference of major TRAE was -0.08 (95% CI, -0.63, 0.46) and rate ratio was 0.90 (95% CI, 0.43, 1.87).
Conclusion:
The rate of major TRAE was low, albeit increased in the liberal transfusion arm proportional to the number of RBC units transfused. The higher rate of major TRAE in the liberal arm was not sufficient to offset the increased rates of myocardial infarction or death at 30 days observed in patients assigned to the restrictive transfusion arm.
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