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Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease

Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina u... Full description

Journal Title: The American heart journal 2013, Vol.165 (6), p.964-971.e1
Main Author: Carson, Jeffrey L., MD
Other Authors: Brooks, Maria Mori, PhD , Abbott, J. Dawn, MD , Chaitman, Bernard, MD , Kelsey, Sheryl F., PhD , Triulzi, Darrell J., MD , Srinivas, Vankeepuram, MD , Menegus, Mark A., MD , Marroquin, Oscar C., MD , Rao, Sunil V., MD , Noveck, Helaine, MPH , Passano, Elizabeth, MS , Hardison, Regina M., MS , Smitherman, Thomas, MD , Vagaonescu, Tudor, MD , Wimmer, Neil J., MD , Williams, David O., MD
Format: Electronic Article Electronic Article
Language: English
Subjects:
Quelle: Alma/SFX Local Collection
Publisher: United States: Mosby, Inc
ID: ISSN: 0002-8703
Link: https://www.ncbi.nlm.nih.gov/pubmed/23708168
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3664840
title: Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease
format: Article
creator:
  • Carson, Jeffrey L., MD
  • Brooks, Maria Mori, PhD
  • Abbott, J. Dawn, MD
  • Chaitman, Bernard, MD
  • Kelsey, Sheryl F., PhD
  • Triulzi, Darrell J., MD
  • Srinivas, Vankeepuram, MD
  • Menegus, Mark A., MD
  • Marroquin, Oscar C., MD
  • Rao, Sunil V., MD
  • Noveck, Helaine, MPH
  • Passano, Elizabeth, MS
  • Hardison, Regina M., MS
  • Smitherman, Thomas, MD
  • Vagaonescu, Tudor, MD
  • Wimmer, Neil J., MD
  • Williams, David O., MD
subjects:
  • Abridged Index Medicus
  • Article
  • Blood Transfusion - methods
  • Cardiac Catheterization
  • Cardiac patients
  • Cardiovascular
  • Care and treatment
  • Coronary Artery Disease - blood
  • Coronary Artery Disease - diagnosis
  • Coronary Artery Disease - therapy
  • Coronary heart disease
  • Coronary vessels
  • Death, Sudden, Cardiac - epidemiology
  • Death, Sudden, Cardiac - prevention & control
  • Decision Making
  • Electrocardiography
  • Follow-Up Studies
  • Heart attacks
  • Hemoglobin
  • Hemoglobins - metabolism
  • Hospitalization
  • Humans
  • Incidence
  • Mortality
  • Pilot Projects
  • Prognosis
  • Retrospective Studies
  • Survival Rate - trends
  • United States - epidemiology
ispartof: The American heart journal, 2013, Vol.165 (6), p.964-971.e1
description: Background Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 0002-8703
fulltext: fulltext
issn:
  • 0002-8703
  • 1097-6744
url: Link


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titleLiberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease
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creatorCarson, Jeffrey L., MD ; Brooks, Maria Mori, PhD ; Abbott, J. Dawn, MD ; Chaitman, Bernard, MD ; Kelsey, Sheryl F., PhD ; Triulzi, Darrell J., MD ; Srinivas, Vankeepuram, MD ; Menegus, Mark A., MD ; Marroquin, Oscar C., MD ; Rao, Sunil V., MD ; Noveck, Helaine, MPH ; Passano, Elizabeth, MS ; Hardison, Regina M., MS ; Smitherman, Thomas, MD ; Vagaonescu, Tudor, MD ; Wimmer, Neil J., MD ; Williams, David O., MD
creatorcontribCarson, Jeffrey L., MD ; Brooks, Maria Mori, PhD ; Abbott, J. Dawn, MD ; Chaitman, Bernard, MD ; Kelsey, Sheryl F., PhD ; Triulzi, Darrell J., MD ; Srinivas, Vankeepuram, MD ; Menegus, Mark A., MD ; Marroquin, Oscar C., MD ; Rao, Sunil V., MD ; Noveck, Helaine, MPH ; Passano, Elizabeth, MS ; Hardison, Regina M., MS ; Smitherman, Thomas, MD ; Vagaonescu, Tudor, MD ; Wimmer, Neil J., MD ; Williams, David O., MD
descriptionBackground Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
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subjectAbridged Index Medicus ; Article ; Blood Transfusion - methods ; Cardiac Catheterization ; Cardiac patients ; Cardiovascular ; Care and treatment ; Coronary Artery Disease - blood ; Coronary Artery Disease - diagnosis ; Coronary Artery Disease - therapy ; Coronary heart disease ; Coronary vessels ; Death, Sudden, Cardiac - epidemiology ; Death, Sudden, Cardiac - prevention & control ; Decision Making ; Electrocardiography ; Follow-Up Studies ; Heart attacks ; Hemoglobin ; Hemoglobins - metabolism ; Hospitalization ; Humans ; Incidence ; Mortality ; Pilot Projects ; Prognosis ; Retrospective Studies ; Survival Rate - trends ; United States - epidemiology
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1Brooks, Maria Mori, PhD
2Abbott, J. Dawn, MD
3Chaitman, Bernard, MD
4Kelsey, Sheryl F., PhD
5Triulzi, Darrell J., MD
6Srinivas, Vankeepuram, MD
7Menegus, Mark A., MD
8Marroquin, Oscar C., MD
9Rao, Sunil V., MD
10Noveck, Helaine, MPH
11Passano, Elizabeth, MS
12Hardison, Regina M., MS
13Smitherman, Thomas, MD
14Vagaonescu, Tudor, MD
15Wimmer, Neil J., MD
16Williams, David O., MD
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1The American heart journal
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descriptionBackground Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
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titleLiberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease
authorCarson, Jeffrey L., MD ; Brooks, Maria Mori, PhD ; Abbott, J. Dawn, MD ; Chaitman, Bernard, MD ; Kelsey, Sheryl F., PhD ; Triulzi, Darrell J., MD ; Srinivas, Vankeepuram, MD ; Menegus, Mark A., MD ; Marroquin, Oscar C., MD ; Rao, Sunil V., MD ; Noveck, Helaine, MPH ; Passano, Elizabeth, MS ; Hardison, Regina M., MS ; Smitherman, Thomas, MD ; Vagaonescu, Tudor, MD ; Wimmer, Neil J., MD ; Williams, David O., MD
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4Kelsey, Sheryl F., PhD
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6Srinivas, Vankeepuram, MD
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9Rao, Sunil V., MD
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13Smitherman, Thomas, MD
14Vagaonescu, Tudor, MD
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abstractBackground Prior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels. Methods We performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization. Results Baseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032). Conclusions The liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
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