title: Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
abstract: BACKGROUND
  Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels.
  
  
  METHODS
  We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization.
  
  
  RESULTS
  Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032).
  
  
  CONCLUSIONS
  The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
authors.affiliation: Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA. carson@umdnj.edu
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.forename: Maria Mori
authors.initials: MM
authors.lastname: Brooks
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.forename: Bernard
authors.initials: B
authors.lastname: Chaitman
authors.forename: Sheryl F
authors.initials: SF
authors.lastname: Kelsey
authors.forename: Darrell J
authors.initials: DJ
authors.lastname: Triulzi
authors.forename: Vankeepuram
authors.initials: V
authors.lastname: Srinivas
authors.forename: Mark A
authors.initials: MA
authors.lastname: Menegus
authors.forename: Oscar C
authors.initials: OC
authors.lastname: Marroquin
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Helaine
authors.initials: H
authors.lastname: Noveck
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Passano
authors.forename: Regina M
authors.initials: RM
authors.lastname: Hardison
authors.forename: Thomas
authors.initials: T
authors.lastname: Smitherman
authors.forename: Tudor
authors.initials: T
authors.lastname: Vagaonescu
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Wimmer
authors.forename: David O
authors.initials: DO
authors.lastname: Williams
mesh_terms: D001803:Blood Transfusion / Q000379:methods*; D006328:Cardiac Catheterization; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control; D003657:Decision Making; D004562:Electrocardiography; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism*; D006801:Humans; D015994:Incidence; D010865:Pilot Projects; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D006454:Hemoglobins