Prospective, randomized trial of higher goal hemoglobin after subarachnoid hemorrhage.
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.
Naidech
Andrew M
AM
Department of Neurology, Northwestern University's Feinberg School of Medicine, 710 N Lake Shore Drive, Chicago, IL 60611, USA. a-naidech@northwestern.edu
Shaibani
Ali
A
Garg
Rajeev K
RK
Duran
Isis M
IM
Liebling
Storm M
SM
Bassin
Sarice L
SL
Bendok
Bernard R
BR
Bernstein
Richard A
RA
Batjer
H Hunt
HH
Alberts
Mark J
MJ
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
D006454:Hemoglobins