Please use this identifier to cite or link to this item: https://doi.org/10.1111/vox.13274
Title: Impact of restrictive red blood cell transfusion strategy on thrombosis-related events: A meta-analysis and systematic review
Authors: Maimaitiming, Mairehaba
Zhang, Chenxiao
Xie, Jingui
Zheng, Zhichao
Luo, Haidong
Ooi, Oon Cheong 
Keywords: Science & Technology
Life Sciences & Biomedicine
Hematology
cerebrovascular accidents
myocardial infarction
restrictive
thromboembolism
transfusion strategy
ACUTE MYOCARDIAL-INFARCTION
HEMOGLOBIN THRESHOLD
CARDIAC-SURGERY
CLINICAL-TRIAL
REQUIREMENTS
MORTALITY
TRIGGER
MORBIDITY
OUTCOMES
INJURY
Issue Date: 25-Mar-2022
Publisher: WILEY
Citation: Maimaitiming, Mairehaba, Zhang, Chenxiao, Xie, Jingui, Zheng, Zhichao, Luo, Haidong, Ooi, Oon Cheong (2022-03-25). Impact of restrictive red blood cell transfusion strategy on thrombosis-related events: A meta-analysis and systematic review. VOX SANGUINIS 117 (7) : 887-899. ScholarBank@NUS Repository. https://doi.org/10.1111/vox.13274
Abstract: Background and Objectives: There is an ongoing controversy regarding the risks of restrictive and liberal red blood cell (RBC) transfusion strategies. This meta-analysis assessed whether transfusion at a lower threshold was superior to transfusion at a higher threshold, with regard to thrombosis-related events, that is, whether these outcomes can benefit from a restrictive transfusion strategy is debated. Materials and Methods: We searched PubMed, Cochrane Central Register of Controlled Trials and Scopus from inception up to 31 July 2021. We included randomized controlled trials (RCTs) in any clinical setting that evaluated the effects of restrictive versus liberal RBC transfusion in adults. We used random-effects models to calculate the risk ratios (RRs) and 95% confidence intervals (CIs) based on pooled data. Results: Thirty RCTs involving 17,334 participants were included. The pooled RR for thromboembolic events was 0.65 (95% CI 0.44–0.94; p = 0.020; I2 = 0.0%, very low-quality evidence), favouring the restrictive strategy. There were no significant differences in cerebrovascular accidents (RR = 0.83; 95% CI 0.64–1.09; p = 0.180; I2 = 0.0%, very low-quality evidence) or myocardial infarction (RR = 1.05; 95% CI 0.87–1.26; p = 0.620; I2 = 0.0%, low-quality evidence). Subgroup analyses showed that a restrictive (relative to liberal) strategy reduced (1) thromboembolic events in RCTs conducted in North America and (2) myocardial infarctions in the subgroup of RCTs where the restrictive transfusion threshold was 7 g/dl but not in the 8 g/dl subgroup (with a liberal transfusion threshold of 10 g/dl in both subgroups). Conclusions: A restrictive (relative to liberal) transfusion strategy may be effective in reducing venous thrombosis but not arterial thrombosis.
Source Title: VOX SANGUINIS
URI: https://scholarbank.nus.edu.sg/handle/10635/235027
ISSN: 0042-9007
1423-0410
DOI: 10.1111/vox.13274
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