A RECENT study has found that a liberal transfusion strategy, compared to a restrictive one, does not significantly improve neurological outcomes in critically ill patients with traumatic brain injury (TBI) and anemia.
Led by Alexis Turgeon, Université Laval, Québec, Canada, this randomised trial involved 742 adults with moderate to severe TBI, who were divided into two groups: one following a liberal strategy of red blood cell transfusion (transfusions initiated at a haemoglobin level of ≤10 g per decilitre) and the other following a restrictive strategy (transfusions initiated at ≤7 g per decilitre).
After six months, the study assessed outcomes using the Glasgow Outcome Scale–Extended, which measures the degree of disability or dependence in daily activities. The results showed that 68.4% of patients in the liberal transfusion group experienced unfavorable outcomes, compared to 73.5% in the restrictive group. However, the adjusted difference between the groups was not statistically significant, indicating that a higher threshold for transfusions did not lead to better neurological outcomes.
Secondary outcomes such as mortality, functional independence, quality of life, and depression were also evaluated. While the liberal strategy was linked to better scores on some scales assessing functional independence and quality of life, it had no impact on mortality or depression rates. Both groups had similar rates of venous thromboembolism, but the liberal strategy was associated with a higher incidence of acute respiratory distress syndrome (3.3% vs. 0.8%).
The findings suggest that a liberal transfusion approach does not offer a clear advantage over a restrictive strategy for improving long-term outcomes in TBI patients with anemia.
Helena Bradbury, EMJ
Reference
Alexis F et al. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. New England Journal of Medicine. 2024.
