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Blood transfusion might increase mortality from acute coronary syndrome.

* CLINICAL QUESTION

Does a blood transfusion in anemic patients with acute coronary syndrome improve survival?

* BOTTOM LINE

Blood transfusion in otherwise stable patients with acute coronary syndrome who acutely develop anemia during hospitalization may increase mortality risk, especially if the hematocrit level is higher than 25%. (LOE=2b)

* STUDY DESIGN

Cohort (prospective)

* SETTING

Inpatient (any location) with outpatient follow-up

* SYNOPSIS

Blood transfusions are routinely performed for patients with ischemic heart disease developing anemia acutely during hospitalization, but evidence of benefit is uncertain. The investigators analyzed data from 24,112 subjects enrolled in 3 large international trials of patients with acute coronary syndromes, evaluating various antithrombotic regimens. Analysis was limited to patients with complete data on transfusion and bleeding occurrence. All endpoints were evaluated (by individuals blinded to treatment group assignment) as to whether subjects received blood transfusions. Because blood transfusion was a postrandomization event left to the discretion of the treating clinician, associations between transfusion and primary and secondary endpoints were evaluated using multiple logistic regression techniques to evaluate independent variables and control for confounding factors.

A total of 2401 patients (10%) underwent at least 1 blood transfusion during their hospitalization. Transfusion was independently related to an increased risk of death at 30 days (hazard ratio= 3.94; 95% confidence interval [CI], 3.26-4.75). The predicted probability of death was higher when a transfusion was performed for hematocrit values higher than 25%, with no benefit or risk detected for transfusions given for values lower than 25%. A previous trial (N Engl J Med 2001; 345:1230-1236) has shown a benefit of selective transfusion in elderly patients hospitalized with acute coronary syndrome and anemia (hematocrit [less than or equal to] 33%) on admission (not acutely developing during hospitalization).

Rao SV, Jollis JG, Harrington RA, et al. Relationship of blood transfusion and clinical outcomes in patients with acute coronary syndromes. JAMA 2004; 292:1555-1562.

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Article Details
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Title Annotation:Patient Oriented Evidence That Matters: practice recommendations from key studies
Author:Rao, S.V.; Jollis, J.G.; Harrington. R.A.
Publication:Journal of Family Practice
Geographic Code:1USA
Date:Jan 1, 2005
Words:313
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