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Sukhon F, Jabri A, Al-Abdouh A, Alameh A, Alhuneafat L, Jebaje ZA, Khader S, Mhanna M, Koenig G, Alaswad K, Villablanca P, AlQarqaz M. Liberal versus conservative transfusion strategy for patients with acute myocardial infarction and anemia: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102247. [PMID: 38040217 DOI: 10.1016/j.cpcardiol.2023.102247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND A hemoglobin (Hb) level goal of 7-8 g/dL is a standard care threshold, prompting blood transfusion. The debate over whether acute myocardial infarction (MI) patients benefit from a more liberal transfusion strategy prompted a meta-analysis of relevant trials. METHODS We performed a meta-analysis of randomized controlled trials (RCTs) comparing liberal and restrictive transfusion strategies in anemic MI patients. Primary outcomes were recurrent MI and death/MI, while secondary outcomes included stroke, revascularization, heart failure, and all-cause mortality. Due to the limited trials, we utilized the Paul-Mendele method with Hartung Knapp adjustment. RESULTS Involving 2155 patients with liberal transfusion and 2170 with conservative transfusion across four RCTs, liberal transfusion did not significantly reduce MI (relative risk [RR] 0.85; 95 % CI 0.72 - 1.02, p = 0.07) or death/MI (RR 0.88; 95 % CI 0.45 - 1.71, p = 0.57). No significant differences were observed in all-cause mortality (RR 0.82; 95 % CI 0.25 - 2.68, p = 0.63), stroke (RR 0.89; 95 % CI 0.48 - 1.64, p = 0.50), revascularization (RR 0.93; 95 % CI 0.48 - 1.80, p = 0.68), or heart failure (RR 1.14; 95 % CI 0.04 - 28.84, p = 0.88). CONCLUSION Our meta-analysis supports current medical guidelines, reinforcing the practice of limiting transfusions in acute MI patients to those with an Hb level of 7 or 8 g/dL. Liberal transfusion strategies did not show improved clinical outcomes.
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Affiliation(s)
- Fares Sukhon
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Ahmad Jabri
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Anas Alameh
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Laith Alhuneafat
- Cardiovascular Disease Insititute, University of Minnesota, Minneapolis, MN, USA
| | - Zaid Al Jebaje
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Safwan Khader
- Heart and Vascular Center, MetroHealth Medical Center, Cleveland, OH, USA
| | - Mohammed Mhanna
- Division of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Gerald Koenig
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA
| | - Mohammad AlQarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University College of Human Medicine, K-2 Office B1417, 2799 W, Grand Blvd, Detroit, MI 48202, USA.
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Al Jebaje Z, Wu M, McNitt S, Vidula H, Chen L, Alexis J, Goldenberg I, Kutyifa V. B-AB23-05 OUTCOMES AND COMPLICATIONS OF CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CONTINUOUS-FLOW LEFT VENTRICULAR ASSIST DEVICES. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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