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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
1   NHS Blood and Transplant, Oxford, UK
2   Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK
,
Katherine S. Colman
3   Monash University Medical School, Melbourne, Victoria, Australia
,
Babette W. Prick
4   Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
,
Johannes J. Duvekot
4   Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, the Netherlands
,
Connor Sweeney
5   Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
,
Ayodele Odutayo
6   Centre for Statistics in Medicine, University of Oxford, UK
,
Vipul Jairath
7   Departments of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
8   Nuffield Department of Medicine, University of Oxford, Oxford, UK
,
Carolyn Doree
9   Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
,
Marialena Trivella
6   Centre for Statistics in Medicine, University of Oxford, UK
,
Sally Hopewell
10   Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, University of Oxford, UK
,
Lise J. Estcourt
1   NHS Blood and Transplant, Oxford, UK
2   Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK
,
Simon J. Stanworth
1   NHS Blood and Transplant, Oxford, UK
2   Oxford Clinical Research in Transfusion Medicine, University of Oxford, UK
› Author Affiliations Financial support: There was no specific funding for this review. SH, LE and MT are partially supported by a National Institute of Health Research (NIHR) Cochrane Programme Grant – Safe and Appropriate Use of Blood Components. This research was also supported by the NIHR Oxford Biomedical Research Centre Programme. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
Further Information

Publication History

Received: 06 January 2017

Accepted after major revision: 02 February 2017

Publication Date:
28 November 2017 (online)

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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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