A RECENT international clinical trial involving 850 patients has revealed that a liberal blood transfusion strategy significantly improves neurological outcomes in individuals with acute brain injuries compared to a restrictive approach.
The study, conducted across 72 intensive care units in 22 countries, assessed patients with traumatic brain injury, aneurysmal subarachnoid haemorrhage, or intracerebral haemorrhage who had haemoglobin levels below 9 g/dL. Participants were randomly assigned to either a liberal transfusion group, receiving transfusions when haemoglobin fell below 9 g/dL, or a restrictive group, triggered at levels below 7 g/dL.
At 180 days, the liberal strategy group exhibited a 10% lower rate of unfavourable neurological outcomes—defined as a Glasgow Outcome Scale Extended score between 1 and 5, compared to the restrictive group (62.6% vs 72.6%, respectively). Adjusted relative risk analysis showed a significant reduction in poor outcomes (relative risk 0.86, P=0.002) in the liberal group.
Patients in the liberal group also experienced fewer cerebral ischemic events (8.8% vs 13.5%, relative risk 0.65). The liberal group received a median of two blood units, while the restrictive group received none or one, on average.
The findings suggest that maintaining higher haemoglobin thresholds via liberal transfusion strategies can reduce the risk of long-term neurological impairment in patients with acute brain injuries, offering a critical adjustment to current transfusion practices in intensive care settings.
Helena Bradbury, EMJ
Reference
Taccone FS et al. Restrictive vs liberal transfusion strategy in patients with acute brain injury: The TRAIN randomized clinical trial. JAMA. 2024;332(19):1623-33.
