Transfusion Strategies for Acute Upper Gastrointestinal Blee
Transfusion Strategies for Acute Upper Gastrointestinal Bleeding
Patient / Population Intervention / Exposition Vergleich Endpunkt
In921 patients with severe acute upper gastrointestinal bleeding,a restrictive transfusion strategyreduced45-day mortalitycompared witha liberal strategy.
N
921
Design
Single-centre, open-label randomised controlled trial in Barcelona (June 2003–December 2009); 921 adults with severe acute upper gastrointestinal bleeding randomised 1:1 to a restrictive (transfuse at haemoglobin <7 g/dL) or liberal (<9 g/dL) red-cell transfusion strategy, stratified by presence of liver cirrhosis; intention-to-treat analysis.
Endpunkt
Primary: death from any cause within 45 days. Secondary: further bleeding, need for rescue therapy, and complications/adverse events.
Ergebnis45-day mortality 5% (23) with the restrictive strategy vs 9% (41) with the liberal strategy; hazard ratio for death 0.55 (95% CI 0.33–0.92), P=0.02, NNT 25. Further bleeding 10% vs 16% (P=0.01) and overall adverse events 40% vs 48% (P=0.02, NNT 13). Half of restrictive-strategy patients (51%) received no transfusion vs 14% liberal (P<0.001). Survival benefit was significant in cirrhosis Child–Pugh A/B (HR 0.30, 95% CI 0.11–0.85) but not Child–Pugh C (HR 1.04). Protocol violations were more frequent in the restrictive arm (39 patients, 9%, vs 15, 3%; P<0.001).
Villanueva C, Colomo A, Bosch A, et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11-21. 10.1056/nejmoa1211801