Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta-analysis.
Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta-analysis.
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DOI：
10.1111/tme.12535
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Natanson C
中科院分区：
文献类型：
--
作者：
Cortés-Puch I;Wiley BM;Sun J;Klein HG;Welsh J;Danner RL;Eichacker PQ;Natanson C
To evaluate risks of restrictive red-blood cell transfusion strategies (hemoglobin 7–8 g/dL) in patients with and without known cardiovascular disease (CVD). Recent guidelines recommend restrictive strategies for CVD-patients hospitalized for non-CVD indications, patients without known CVD and patients hospitalized for CVD corrective procedures. Database searches were conducted through December 2017 for randomized-clinical trials that enrolled patients with and without known CVD, hospitalized either for CVD corrective procedures or non-cardiac indications, comparing effects of liberal to restrictive strategies on major adverse coronary events (MACE) and death. In CVD patients not undergoing cardiac interventions, a liberal strategy decreased (p=0.01) the relative risk (95%CI) (RR) of MACE [0.50 (0.29–0.86)] (I2=0%). Among patients without known CVD, the incidence of MACE was lower (1.7 vs 3.9%), and the effect of a liberal strategy on MACE [0.79, (0.39–1.58)] was smaller and nonsignificant, but not different from CVD patients (p=0.30). Combining all CVD and non-CVD patients, a liberal strategy decreased MACE [0.59, (0.39–0.91); p=0.02]. Conversely, among studies reporting mortality, a liberal strategy decreased mortality in CVD patients (11.7% vs.13.3%), but increased mortality (19.2% vs. 18.0%) in patients without known-CVD [interaction p=0.05; ratio of RR 0.73, (0.53–1.00)]. A liberal strategy also did not benefit patients undergoing cardiac surgery; data was insufficient for percutaneous cardiac procedures. In patients hospitalized for non-cardiac indications, liberal transfusion strategies are associated with a decrease risk of MACE in both those with and without known CVD. However, this only provides a survival benefit to CVD-patients not admitted for CVD corrective procedures.
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