For acute MI and anemia, the primary outcome of 30-day mortality or MI does not differ with a restrictive versus liberal transfusion strategy, but a restrictive strategy is associated with increased all-cause mortality at 6 months, according to research published in NEJM Evidence. Jeffrey Carson, MD, and colleagues randomly assigned patients to a restrictive (transfusion threshold, 7-8 g/dL) or liberal (transfusion threshold, 10 g/dL) red cell transfusion strategy. Data were included for 4,311 patients. The primary outcome (composite of 30-day mortality or MI) occurred in 15.4% and 13.8% of patients in the restrictive and liberal strategy groups, respectively (relative risk [RR], 1.13). Death at 30 days occurred in 9.3% and 8.1% of patients in the restrictive and liberal strategy groups, respectively (RR, 1.15), while cardiac death at 30 days occurred in 5.5% and 3.7%, respectively (RR, 1.47). All-cause mortality at 6 months occurred in 20.5% and 19.1% of patients in the restrictive and liberal strategy groups (HR, 1.08), respectively.
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