1.
Impact of red blood cell transfusion on acute coronary syndrome: a meta-analysis
Wang Y, Shi X, Du R, Chen Y, Zhang Q
Internal & Emergency Medicine. 13(2):231-241, 2018 03.. 2018;13((2):):231-241
Abstract
The impact of red blood cell transfusion on outcomes in patients with acute coronary syndrome is controversial. Pubmed, EMBASE, and Cochrane Library were searched for studies of red blood cell transfusion and acute coronary syndrome that were published in any language, from January 1, 1966, to April 1, 2016. We analyzed 17 observational studies, of 2,525,550 subjects. We conducted a systematic review with meta-analysis of studies assessing the association between blood transfusion and the risk for all-cause mortality and reinfarction. The search yielded 17 observational studies, of 2,525,550 subjects, during a study follow-up period, ranging from 30 days to 5 years. Red blood cell transfusion compared with no blood transfusion is associated with higher short- and long-term all-cause mortality as well as reinfarction rates (adjusted RR 2.23; 95% CI 1.47-3.39; HR 1.93; 95% CI 1.12-3.34; RR 2.61; 95% CI 2.17-3.14, respectively). In hemoglobin-stratified analyses, a graded association between red blood cell transfusion and mortality was observed, transfusion and risk of all-cause mortality was borderline significant at hemoglobin levels below 8.0 g/dL (RR 0.52; 95% CI 0.25-1.06), and was associated with an increased risk of mortality at a hemoglobin above 10 g/dL (RR 3.34; 95% CI 2.25-4.97). Red blood cell transfusion was associated with an increased risk of short- and long-term mortality as well as myocardial reinfarction. However, transfusion appeared to have beneficial or neutral effects on mortality at hemoglobin levels below 8.0 g/dL, and harmful effects above 10 g/dL. A large definitive randomized controlled trial addressing this issue is urgently required.
2.
Restrictive versus liberal blood transfusion in patients with coronary artery disease: a meta-analysis
Wang Y, Shi X, Wen M, Chen Y, Zhang Q
Current Medical Research and Opinion. 2017;:1-17.
Abstract
OBJECTIVES To compare clinical outcomes between restrictive versus liberal blood transfusion strategies in patients with coronary artery disease (CAD). RESEARCH DESIGN AND METHODS A literature search from January 1966 to May 2016 was performed in Pubmed, EMBASE and Cochrane Library to find trials evaluating a restrictive hemoglobin transfusion trigger of ≤8 g/dL, compared with a more liberal trigger. Two study authors independently extracted data from the trials. Primary outcome was mortality and secondary outcome was subsequent myocardial infarction. Relative risk (RR) with their 95% confidence intervals (CIs) was assessed. RESULTS Six trials involving 133,058 participants were included in this study. Pooled results revealed no difference in mortality was found between the liberal transfusion and restrictive transfusion (RR = 1.17, 95% CI = 0.91-1.52, P = 0.22). Subgroup analysis revealed that restrictive transfusion strategy was associated with a higher risk of in-hospital mortality (RR = 1.38, 95% CI = 1.15-1.67, P < 0.001) and 30-day mortality (RR = 1.21, 95% CI = 1.01-1.45, P = 0.03), compared with the liberal strategy. No significant difference was found between the liberal transfusion strategy and restrictive transfusion strategy in risk for subsequent myocardial infarction (RR = 1.09, 95% CI = 0.57-2.06, P = 0.80). LIMITATIONS Limitations include (1) limited number of trials, especially those evaluating myocardial infarction, (2) observed heterogeneity, (3) confounding by indication and other inherent bias may exist. CONCLUSION The findings suggest that restrictive blood transfusion was associated with higher in-hospital and 30-day mortality than liberal blood transfusion in CAD patients. The conclusions are mainly based on retrospective studies and should not be considered as recommendation before they are supported by RCTs.
3.
Effects of erythropoiesis-stimulating agents on heart failure patients with anemia: a meta-analysis
Zhang H, Zhang P, Zhang Y, Yan J, Dong P, Wang Y, Niu X
Postepy W Kardiologii Interwencyjnej = Advances in Interventional Cardiology. 2016;12((3)):247-53.
Abstract
INTRODUCTION Heart failure (HF) is always complicated with anemia and is associated with bad prognosis in this patient population. Several studies have assessed the potential role of erythropoietin-stimulating agent (ESA) in improving cardiac function and reducing the number of hospitalizations in anemic patients with HF. AIM: We performed a meta-analysis to assess the potential role of ESA in the treatment of anemic patients with HF. MATERIAL AND METHODS A literature and Medline search was performed to identify studies with control groups that examined the efficacy of ESA therapy in patients with HF and anemia. RESULTS A total of 11 studies were included (n = 3044 subjects) in the final analysis. Compared to placebo, ESA therapy was associated with increased hemoglobin levels (1.89 g/dl; 95% CI: 1.64-2.14, p < 0.00001), increased left ventricular ejection fraction (LVEF) to 6.88 (95% CI: 0.49-13.28, p = 0.03), decreased B-type natriuretic protein (-272.20; 95% CI: (-444.52)-(-99.89), p = 0.002), improvement in New York Heart Association functional class to -0.33 mean difference (95% CI: (-0.44)-(-0.23), p < 0.00001), and decreased hospitalization (OR = 0.61, 95% CI: 0.39-0.94, p = 0.02). There was no significant between-group difference in all-cause mortality (OR = 0.78, 95% CI: 0.51-1.21, p = 0.27). CONCLUSIONS The treatment of anemia with ESA therapy did not reduce the rate of all-cause mortality among patients with heart failure, but ESA therapy made a potential important contribution to patients' symptomatic improvement.