A restrictive blood transfusion strategy showed no significant difference in 30-day MACE compared to a liberal strategy (RR 0.93; 95% CI 0.57-1.51; P=0.76) but reduced acute lung injury.
Meta-Analysis (n=4,325)
Does a restrictive blood transfusion strategy improve clinical outcomes compared to a liberal strategy in patients with acute myocardial infarction and anemia?
A restrictive blood transfusion strategy in patients with AMI and anemia yields similar clinical outcomes to a liberal strategy but is associated with a lower incidence of acute lung injury.
Relative Risk: 0.93 (95% CI 0.57–1.51)
p-value: p=0.76
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.
Amin et al. (Mon,) conducted a meta-analysis in Acute myocardial infarction and anemia (n=4,325). Restrictive blood transfusion strategy vs. Liberal blood transfusion strategy was evaluated on MACE at 30 days (RR 0.93, 95% CI 0.57-1.51, p=0.76). A restrictive blood transfusion strategy showed no significant difference in 30-day MACE compared to a liberal strategy (RR 0.93; 95% CI 0.57-1.51; P=0.76) but reduced acute lung injury.