• Jeffrey L Carson, Maria Mori Brooks, J Dawn Abbott, Bernard Chaitman, Sheryl F Kelsey, Darrell J Triulzi, Vankeepuram Srinivas, Mark A Menegus, Oscar C Marroquin, Sunil V Rao, Helaine Noveck, Elizabeth Passano, Regina M Hardison, Thomas Smitherman, Tudor Vagaonescu, Neil J Wimmer, and David O Williams.
• Division of General Internal Medicine, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ, USA. carson@umdnj.edu
• Am. Heart J. 2013 Jun 1;165(6):964-971.e1.

BackgroundPrior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels.MethodsWe performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization.ResultsBaseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032).ConclusionsThe liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.Copyright © 2013 Mosby, Inc. All rights reserved.

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