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Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta-analysis

Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. National Institutes of Health Library, National Institutes of Health, Bethesda, Maryland, USA. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA. Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.

Transfusion Medicine (Oxford, England). 2018;28((5):):335-345.
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Abstract
AIM: To evaluate the risks of restrictive red blood cell transfusion strategies (haemoglobin 7-8 g dL(-1) ) in patients with and without known cardiovascular disease (CVD). BACKGROUND Recent guidelines recommend restrictive strategies for CVD patients hospitalised for non-CVD indications, patients without known CVD and patients hospitalised for CVD corrective procedures. METHODS/MATERIALS Database searches were conducted through December 2017 for randomised clinical trials that enrolled patients with and without known CVD, hospitalised either for CVD-corrective procedures or non-cardiac indications, comparing effects of liberal with restrictive strategies on major adverse coronary events (MACE) and death. RESULTS In CVD patients not undergoing cardiac interventions, a liberal strategy decreased (P = 0.01) the relative risk (95% CI) (RR) of MACE [0.50 (0.29-0.86)] (I(2) = 0%). Among patients without known CVD, the incidence of MACE was lower (1.7 vs 3.9%), and the effect of a liberal strategy on MACE [0.79, (0.39-1.58)] was smaller and non-significant but not different from CVD patients (P = 0.30). Combining all CVD and non-CVD patients, a liberal strategy decreased MACE [0.59, (0.39-0.91); P = 0.02]. Conversely, among studies reporting mortality, a liberal strategy decreased mortality in CVD patients (11.7% vs.13.3%) but increased mortality (19.2% vs 18.0%) in patients without known CVD [interaction P = 0.05; ratio of RR 0.73, (0.53-1.00)]. A liberal strategy also did not benefit patients undergoing cardiac surgery; data were insufficient for percutaneous cardiac procedures. CONCLUSIONS In patients hospitalised for non-cardiac indications, liberal transfusion strategies are associated with a decreased risk of MACE in both those with and without known CVD. However, this only provides a survival benefit to CVD patients not admitted for CVD-corrective procedures.
Study details
Study Design : Systematic Review
Language : English
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine