Blood transfusion in patients with coronary syndromes and anaemia: a systematic review and a meta-analysis of randomized controlled trials. (3rd October 2022)

• Record Type: Journal Article
• Authors: Herrera, C; Vernooij, R W M; Marcos, M; Martinez-Selles, M
• Is Part Of: European heart journal. Volume 43(2022)Supplement 2
• Publication Date: 2022-10-03
• Subjects: Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac544.1371
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: The estimated prevalence of anaemia on admission in the setting of acute coronary syndromes (ACS) is between 10 to 43% and up to 57% of the patients may develop hospital-acquired anaemia. The best blood transfusion strategy in anemic patients with symptomatic coronary syndromes remains unclear. Purpose: We aimed to perform a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the effect of different transfusion strategies in anemic patients with coronary syndromes on 30-day mortality, major adverse cardiovascular events (MACE), and non-cardiovascular complications. Methods: We searched for all randomized trials comparing restrictive to conservativestrategy in patients with coronary syndromes published up to 16 th November 2021 on PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov without language, sample size, publication date or other data restrictions. All studies were assessed for bias using Cochrane risk of bias, and meta-analysed using a random effect model. The quality of evidence was evaluated by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. The pre-specified primary outcome was all-cause death at 30 days. The secondary outcome was the composite of non-fatal recurrent myocardial infarction, non-fatal stroke, emergency revascularization, or cardiovascular death at 30 days (MACE). Safety endpoint was a combination of de novo or worsening congestive heart failure, stent thrombosis, venous thromboembolism, pneumonia, or blood stream infection. Results: Three RCT (CRIT, MINT and REALITY) were included with 820 patients. The risk of bias was considered low, except for blinding of patients and healthcare professionals. Across the three studies, a total of 55 patients died in the first 30 days. We found no differences between restrictive transfusion strategy compared with liberal transfusion strategy in all-cause death at 30 days (risk ratio [RR]: 1.61, 95% confidence interval [CI] 0.38–6.90, I 2 =59%, MACE (RR: 1.16, 95% CI 0.49–2.71; I 2 =62%; figure 1) and incidence of adverse events (RR: 1.52, 95% CI 0.56–4.09; I 2 =60%; figure 2). The quality of evidence was considered low to moderate due to concerns of imprecision and inconsistency. Conclusion(s): Liberal and conservative strategies of blood transfusion show similar results in anaemic patients with symptomatic coronary syndromes. As blood is a scarce resource, our data support the current guideline recommendation of restrictive strategy of transfusion in anaemic patients with acute coronary syndromes. Funding Acknowledgement: Type of funding sources: None.