Liberal Transfusion Strategy Not Beneficial for Patients With TBI, Anemia

No significant change seen in unfavorable neurologic outcome as assessed by score on GOS-E at six months
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Medically Reviewed By:
Mark Arredondo, M.D.

MONDAY, July 1, 2024 (HealthDay News) -- A liberal transfusion strategy does not reduce the risk of unfavorable neurologic outcome at six months among critically ill patients with traumatic brain injury and anemia, according to a study published online June 13 in the New England Journal of Medicine to coincide with the annual Critical Care Reviews Meeting, held from June 12 to 14 in Belfast, Northern Ireland.

Alexis F. Turgeon, M.D., from the Université Laval in Quebec City, and colleagues randomly assigned 742 adults with moderate or severe traumatic brain injury and anemia to receive transfusion of red cells according to a liberal strategy (initiated at a hemoglobin level of ≤10 g/dL) or a restrictive strategy (transfusions initiated at ≤7 g/dL); 371 patients were assigned to each group.

The researchers found that the median hemoglobin level in the intensive care unit was 10.8 and 8.8 g/dL among those assigned to the liberal and restrictive strategies, respectively. An unfavorable neurologic outcome as assessed by the score on the Glasgow Outcome Scale-Extended (GOS-E) at six months occurred in 68.4 and 73.5 percent of patients in the liberal-strategy and restrictive-strategy groups, respectively (adjusted absolute difference, 5.4 percentage points; 95 percent confidence interval, −2.9 to 13.7). A liberal strategy was associated with higher scores on some but not all scales assessing functional independence and quality of life among survivors. Transfusion strategy was not associated with mortality or depression.

"Although several patient-reported outcomes suggest potentially better results with a liberal strategy, firm conclusions may not be drawn," the authors write.

Several authors disclosed ties to the biopharmaceutical industry.

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