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Editor's Choice
  • Amin AM
  • Ali K
  • Elbenawi H
  • Saber A
  • Abuelazm M
  • et al.
Coron Artery Dis. 2024 May 1;35(3):239-251 doi: 10.1097/MCA.0000000000001349.
POPULATION:

Patients with acute myocardial infarction and anaemia (4 randomised controlled trials, n= 4,325).

INTERVENTION:

Restrictive blood transfusion strategy (n= 2,170).

COMPARISON:

Liberal blood transfusion strategy (n= 2,155).

OUTCOME:

There was no significant difference between both groups regarding major adverse cardiovascular events whether at 30 days (risk ratio (RR) 0.93; 95% CI [0.57, 1.51]) or ≥ six months (RR 1.17; 95% CI [0.95, 1.45]), all-cause mortality at 30 days (RR 1.16; 95% CI [0.95, 1.40]) or ≥ six months (RR 1.16; 95% CI [0.88, 1.53]). The liberal strategy was significantly associated with increased haemoglobin level change (mean difference: -1.44; 95% CI [-1.68, -1.20]). The restrictive strategy was significantly associated with a lower incidence of acute lung injury (RR 0.11; 95% CI [0.02, 0.60].

BACKGROUND:

Blood transfusion strategies in patients with acute myocardial infarction (AMI) and anemia are yet to be conclusively identified. Thus, we aim to assess the efficacy and safety of restrictive versus liberal blood transfusion strategies for AMI and anemia.

METHODS:

A systematic review and meta-analysis of randomized controlled trials (RCTs) retrieved from PubMed, web of science, SCOPUS, EMBASE, and Cochrane Central Register of Controlled Trials were performed through November 2023. We used RevMan V. 5.4 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI). (PROSPERO): ID: CRD42023490692.

RESULTS:

We included four RCTs with 4.325 patients. There was no significant difference between both groups regarding MACE whether at 30 days (RR: 0.93 with 95% CI [0.57-1.51], P  = 0.76) or ≥ six months (RR: 1.17 with 95% CI [0.95-1.45], P  = 0.14), all-cause mortality at 30 days (RR: 1.16 with 95% CI [0.95-1.40], P  = 0.14) or ≥ six months (RR: 1.16 with 95% CI [0.88-1.53], P  = 0.28). However, the liberal strategy was significantly associated with increased hemoglobin level change (MD: -1.44 with 95% CI [-1.68 to -1.20], P  < 0.00001). However, the restrictive strategy was significantly associated with a lower incidence of acute lung injury (RR: 0.11 with 95% CI [0.02-0.60], P  = 0.01).

CONCLUSION:

There was no significant difference between the restrictive blood transfusion strategy and the liberal blood transfusion strategy regarding the clinical outcomes. However, restrictive blood transfusion strategy was significantly associated with a lower incidence of acute lung injury than liberal blood transfusion strategy.

Editor's Choice
  • Prescott B
  • Jackson DE
Hematol Transfus Cell Ther. 2023 Oct 14; doi: 10.1016/j.htct.2023.07.013.
POPULATION:

Rh(D) alloimmunised pregnant women (15 studies).

INTERVENTION:

Systematic review and meta-analysis to determine the effectiveness and safety of intrauterine transfusions (IUTs).

COMPARISON:

OUTCOME:

The forest plots all showed statistically significant outcomes with heterogeneity of data. Results indicated a greater foetal survival rate with IUT to treat anaemic foetuses, a low foetal mortality rate, and low risk of procedure-related complications associated with foetal loss but a higher risk of foetal mortality when hydrops is present.

BACKGROUND:

Foetal anaemia is caused by a severe pregnancy complication, haemolytic disease of the foetus and newborn. Intrauterine transfusions (IUTs) are performed to treat foetal anaemia in alloimmunised pregnant women. If left untreated hydrops can develop thereby reducing the chance of survival. Survival rates have improved but the procedure is not without complications. Procedure-related complications can be associated with early gestational age, hence delaying IUT could improve outcomes. This review aims to determine the effectiveness and safety of IUTs by examining survival and mortality rates, procedure-related complications with associated foetal mortality and the influence of hydrops.

STUDY DESIGN AND METHOD:

A systematic review was conducted by searching keywords in four scientific databases from January 2000 to April 2022. A meta-analysis was performed with the OpenMeta-Analyst software using an arcsine transformed proportion with the binary random-effects model and maximum likelihood method.

RESULTS:

Fifteen studies were identified as eligible and used in the meta-analysis. The forest plots all showed statistically significant outcomes with heterogeneity of data. Results indicated a greater foetal survival rate with IUT to treat anaemic foetuses, a low foetal mortality rate, and low risk of procedure-related complications associated with foetal loss but a higher risk of foetal mortality when hydrops is present.

CONCLUSION:

The findings of this systematic review and meta-analysis provide evidence that IUT is a safe and effective treatment for foetal anaemia in the absence of hydrops when experienced personnel perform the procedure to minimise the risk of procedure-related complications.