Key result
A liberal transfusion strategy compared to a restrictive strategy showed no difference in the change of VASP-PRI platelet reactivity (difference 1.2%; 95% CI -10.3 to 12.7%) in MI patients with anemia.
Why the study?
Higher rates of thrombotic events occur in MI patients requiring blood transfusion, but the impact of blood transfusion strategy on thrombosis and inflammation remains unknown.
Does a liberal transfusion strategy reduce platelet reactivity and biomarkers of thrombosis and inflammation in myocardial infarction patients with anemia compared to a restrictive strategy?
RCT (n=100)
Blinded outcome assessment
Yes
Does a liberal transfusion strategy reduce platelet reactivity and biomarkers of thrombosis and inflammation in myocardial infarction patients with anemia compared to a restrictive strategy?
In MI patients with anemia, a liberal transfusion strategy did not significantly alter platelet reactivity or biomarkers of thrombosis and inflammation compared to a restrictive strategy, though the analysis was underpowered.
Answers are grounded in this paper and cite their sources.
No difference in platelet reactivity or biomarkers between strategies; leaves open optimal transfusion threshold in anemic MI.
BACKGROUND: Higher rates of thrombotic events have been reported in myocardial infarction (MI) patients requiring blood transfusion. The impact of blood transfusion strategy on thrombosis and inflammation is still unknown. OBJECTIVE: To compare the impact of a liberal vs. a restrictive transfusion strategy on P2Y12 platelet reactivity and biomarkers in the multicentric randomized REALITY trial. METHODS: Patients randomized to a liberal (hemoglobin ≤10 g/dL) or a restrictive (hemoglobin ≤8 g/dL) transfusion strategy had VASP-PRI platelet reactivity measured centrally in a blinded fashion and platelet reactivity unit (PRU) measured locally using encrypted VerifyNow; at baseline and after randomization. Biomarkers of thrombosis (P-selectin, PAI-1, vWF) and inflammation (TNF-α) were also measured. The primary endpoint was the change in the VASP-PRI (difference from baseline and post randomization) between the randomized groups. RESULTS: A total of 100 patients randomized were included in this study (n = 50 in each group). Transfused patients received on average 2.4 ± 1.6 units of blood. We found no differences in change of the VASP PRI (difference 1.2% 95% CI (-10.3-12.7%)) or by the PRU (difference 13.0 95% CI (-21.8-47.8)) before and after randomization in both randomized groups. Similar results were found in transfused patients (n = 71) regardless of the randomized group, VASP PRI (difference 1.7%; 95% CI (-9.5-1.7%)) or PRU (difference 27.0; 95% CI (-45.0-0.0)). We did not find an impact of transfusion strategy or transfusion itself in the levels of P-selectin, PAI-1, vWF, and TNF-α. CONCLUSION: In this study, we found no impact of a liberal vs. a restrictive transfusion strategy on platelet reactivity and biomarkers in MI patients with anemia. A conclusion that should be tempered due to missing patients with exploitable biological data that has affected our power to show a difference.
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Silvain et al. (2023) conducted an RCT in Myocardial infarction with anemia (n=100). Liberal transfusion strategy vs. Restrictive transfusion strategy (hemoglobin ≤8 g/dL) was evaluated on Change in the VASP-PRI (difference from baseline and post randomization) between the randomized groups (Difference 1.2%, 95% CI -10.3-12.7). A liberal transfusion strategy compared to a restrictive strategy showed no difference in the change of VASP-PRI platelet reactivity (difference 1.2%; 95% CI -10.3 to 12.7%) in MI patients with anemia.
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