title: Prospective, randomized trial of higher goal hemoglobin after subarachnoid hemorrhage.
abstract: OBJECTIVE
  In patients with subarachnoid hemorrhage (SAH), higher hemoglobin (HGB) has been associated with better outcomes, but packed red blood cell (PRBC) transfusions with worse outcomes. We performed a prospective pilot trial of goal HGB after SAH.
  
  
  METHODS
  Forty-four patients with SAH and high risk for vasospasm were randomized to goal HGB concentration of at least 10 or 11.5 g/dl. We obtained blinded clinical outcomes at 14 days (NIH Stroke Scale and modified Rankin Scale, mRS), 28 days (mRS), and 3 months (mRS), and blinded interpretation of brain MRI for cerebral infarction at 14 days. This trial is registered at www.stroketrials.org.
  
  
  RESULTS
  Forty-four patients were randomized. Patients with goal HGB 11.5 g/dl received more PRBC units per transfusion [1 (1-2) vs. 1 (1-1), P < 0.001] and more total PRBC units [3 (2-4) vs. 2 (1-3), P = 0.045]. Prospectively defined safety endpoints were not different between groups. HGB concentration was different between study groups from day 4 onwards. The number of cerebral infarctions on MRI (6 of 20 vs. 9 of 22), NIH Stroke Scale scores at 14 days [1 (0-9.75) vs. 2 (0-16)], and rates of independence on the mRS at 14 days (65% vs. 44%) and 28 days (80% vs. 67%) were similar, but favored higher goal HGB (P > 0.1 for all).
  
  
  CONCLUSIONS
  Higher goal hemoglobin in patients with SAH seems to be safe and feasible. A phase III trial of goal HGB after SAH is warranted.
authors: Department of Neurology, Northwestern University's Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL 60611, USA. a-naidech@northwestern.edu
authors: Andrew M
authors: AM
authors: Naidech
authors: Ali
authors: A
authors: Shaibani
authors: Rajeev K
authors: RK
authors: Garg
authors: Isis M
authors: IM
authors: Duran
authors: Storm M
authors: SM
authors: Liebling
authors: Sarice L
authors: SL
authors: Bassin
authors: Bernard R
authors: BR
authors: Bendok
authors: Richard A
authors: RA
authors: Bernstein
authors: H Hunt
authors: HH
authors: Batjer
authors: Mark J
authors: MJ
authors: Alberts
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood* / Q000453:epidemiology / Q000628:therapy*; D002544:Cerebral Infarction / Q000097:blood / Q000453:epidemiology / Q000473:pathology; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data; D017707:Erythrocyte Transfusion; D005260:Female; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000453:epidemiology / Q000473:pathology; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000097:blood / Q000453:epidemiology / Q000473:pathology
chemical_list: D006454:Hemoglobins