Potential benefits of restrictive transfusion in upper gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials

Centre for Translational Medicine, Semmelweis University, Budapest, Hungary. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, 7624, Hungary. Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary. Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary. Military Hospital-State Health Centre, Budapest, Hungary. First Department of Medicine, Medical School, University of Pécs, Pécs, Hungary. Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary. Centre for Translational Medicine, Semmelweis University, Budapest, Hungary. eross.balint@pte.hu. Institute for Translational Medicine, Medical School, University of Pécs, Pécs, 7624, Hungary. eross.balint@pte.hu. Institute of Pancreatic Diseases, Semmelweis University, Budapest, Hungary. eross.balint@pte.hu.

Scientific reports. 2023;13(1):17301
Abstract
The optimal red blood cell (RBC) transfusion strategy in acute gastrointestinal bleeding (GIB) is debated. We aimed to assess the efficacy and safety of restrictive compared to liberal transfusion strategies in the GIB population. We searched PubMed, CENTRAL, Embase, and Web of Science for randomised controlled trials on 15.01.2022 without restrictions. Studies comparing lower to higher RBC transfusion thresholds after GIB were eligible. We used the random effect model and calculated pooled mean differences (MD), risk ratios (RR) and proportions with 95% confidence intervals (CI) to calculate the overall effect size. The search yielded 3955 hits. All seven eligible studies reported on the upper GIB population. Restrictive transfusion did not increase the in-hospital- (RR: 0.94; CI 0.46, 1.94) and 30-day mortality (RR: 0.71; CI 0.35, 1.45). In-hospital- and 28 to 45-day rebleeding rate was also not higher with the restrictive modality (RR: 0.67; CI 0.30, 1.50; RR:0.75; CI 0.49, 1.16, respectively). Results of individual studies showed a lower rate of transfusion reactions and post-transfusion intervention if the transfusion was started at a lower threshold. A haemoglobin threshold > 80 g/L may result in a higher untoward outcome rate. In summary, restrictive transfusion does not appear to lead to a higher rate of significant clinical endpoints. The optimal restrictive transfusion threshold should be further investigated.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine