Impact of Red Cell Transfusion Thresholds in Myocardial Infarction and Central Nervous System Haemorrhage: A Systematic Review

This systematic review integrated the evidence comparing liberal and restrictive transfusion strategies to provide recommendations to guide clinical practice in these patient populations. A systematic review was performed, searching for randomised controlled trials and observational cohort studies that compared red blood cell transfusion thresholds among adult patients with MI and central nervous system (CNS) haemorrhage. Study design, patient population, haemoglobin thresholds, transfusion approach, clinical outcomes and follow-up durations were extracted. Risk of bias was evaluated with the Cochrane Risk of Bias 2.0 tool and the Risk of Bias in non-randomised studies of interventions tool. Qualitative and quantitative synthesis of the evidence was carried out. In some studies, restrictive transfusion thresholds (typically 7–8 g/dL) were contrasted with liberal thresholds (typically 9–10 g/dL). The results showed that restrictive transfusion thresholds were non-inferior to liberal thresholds for 30-day major adverse cardiac events (risk difference of 1.5%, 95% confidence interval [CI] −2.8% to 5.8%) and neurological status at discharge (risk difference of 3.2%, 95% CI − 4.1% to 10.5%). Restrictive transfusion strategies were equally effective and safe as liberal strategies in the treatment of anaemia in MI patients and CNS haemorrhage patients.