title: Restrictive vs liberal transfusion for upper gastrointestinal bleeding: a meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  To compare the outcome of upper gastrointestinal bleeding (UGIB) between patients receiving restrictive and liberal transfusion.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Library databases were employed to identify all relevant randomized controlled trials regarding the outcome of UGIB after restrictive or liberal transfusion. Primary outcomes were death and rebleeding. Secondary outcomes were length of hospitalization, amount of blood transfused, and hematocrit and hemoglobin at discharge or after expansion.
  
  
  RESULTS
  Overall, 4 papers were included in this meta-analysis. The incidence of death was significantly lower in patients receiving restrictive transfusion than those receiving liberal transfusion (OR: 0.52, 95%CI: 0.31-0.87, P = 0.01). The incidence of rebleeding was lower in patients receiving restrictive transfusion than those receiving liberal transfusion, but this difference did not reach any statistical significance (OR: 0.26, 95%CI: 0.03-2.10, P = 0.21). Compared with those receiving liberal transfusion, patients receiving restrictive transfusion had a significantly shorter length of hospitalization (standard mean difference: -0.17, 95%CI: -0.30--0.04, P = 0.009) and a significantly smaller amount of blood transfused (standard mean difference: -0.74, 95%CI: -1.15--0.32, P = 0.0005) with a lower hematocrit and hemoglobin level at discharge or after expansion.
  
  
  CONCLUSIONS
  Restrictive transfusion should be employed in patients with UGIB.
authors.affiliation: Juan Wang, Xing-Shun Qi, Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang 110042, Liaoning Province, China.
authors.forename: Juan
authors.initials: J
authors.lastname: Wang
authors.forename: Yong-Xin
authors.initials: YX
authors.lastname: Bao
authors.forename: Ming
authors.initials: M
authors.lastname: Bai
authors.forename: Yong-Guo
authors.initials: YG
authors.lastname: Zhang
authors.forename: Wen-Da
authors.initials: WD
authors.lastname: Xu
authors.forename: Xing-Shun
authors.initials: XS
authors.lastname: Qi
mesh_terms: D015415:Biomarkers / Q000097:blood; D001803:Blood Transfusion / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006400:Hematocrit; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006454:Hemoglobins
keywords: Blood transfusion; Meta-analysis; Randomized controlled trial; Upper gastrointestinal bleeding