Effect of restrictive versus liberal red cell transfusion strategies on haemostasis: systematic review and meta-analysis

Michael J. R. Desborough; Katherine S. Colman; Babette W. Prick; Johannes J. Duvekot; Connor Sweeney; Ayodele Odutayo; Vipul Jairath; Carolyn Doree; Marialena Trivella; Sally Hopewell; Lise J. Estcourt; Simon J. Stanworth

doi:10.1160/TH17-01-0015

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2017; 117(05): 889-898
DOI: 10.1160/TH17-01-0015

Coagulation and Fibrinolysis

Schattauer GmbH

Effect of restrictive versus liberal red cell transfusion strategies on haemostasis: systematic review and meta-analysis

Michael J. R. Desborough

¹NHS Blood and Transplant, Oxford, UK

²Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK

,

Katherine S. Colman

³Monash University Medical School, Melbourne, Victoria, Australia

,

Babette W. Prick

⁴Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands

,

Johannes J. Duvekot

⁴Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands

,

Connor Sweeney

⁵Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

,

Ayodele Odutayo

⁶Centre for Statistics in Medicine, University of Oxford, UK

,

Vipul Jairath

⁷Departments of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada

⁸Nuffield Department of Medicine, University of Oxford, Oxford, UK

,

Carolyn Doree

⁹Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK

,

Marialena Trivella

⁶Centre for Statistics in Medicine, University of Oxford, UK

,

Sally Hopewell

¹⁰Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, University of Oxford, UK

,

Lise J. Estcourt

¹NHS Blood and Transplant, Oxford, UK

²Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK

,

Simon J. Stanworth

¹NHS Blood and Transplant, Oxford, UK

²Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK

› Institutsangaben

Abstract

Summary

Red cells play a key role in normal haemostasis in vitro but their importance clinically is less clear. The objective of this meta-analysis was to assess if correction of anaemia by transfusing red cells at a high haemoglobin threshold (liberal transfusion) is superior to transfusion at a lower haemoglobin threshold (restrictive transfusion) for reducing the risk of bleeding or thrombotic events. We searched for randomised controlled trials in any clinical setting that compared two red cell transfusion thresholds and investigated the risk of bleeding. We searched for studies published up to October 19, 2016 in The Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Embase, and the Transfusion Evidence Library and ISI Web of Science. Relative risks (RR) or Peto Odds Ratios (pOR) were pooled using a random-effect model. Nineteen randomised trials with 9852 participants were eligible for inclusion in this review. Overall there was no difference in the risk of any bleeding between transfusion strategies (RR 0.91, 95 % confidence interval [CI] 0.74 to 1.12). The risk of severe or life-threatening bleeding was lower with a restrictive strategy (RR 0.75, 95 % CI 0.57 to 0.99). There was no difference in the risk of thrombotic events (RR 0.83, 95 % CI 0.61 to 1.13). The risk of any bleeding was not reduced with liberal transfusion and there was no overall difference in the risk of thrombotic events. Data from the included trials do not support aiming for a high haemoglobin threshold to improve haemostasis. PROSPERO registration number CRD42016035519.

Supplementary Material to this article is available online at www.thrombosis-online.com.

Keywords

Haemorrhage - myocardial infarction - transfusion - stroke - venous thromboembolism

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Referenzen

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