Clinical Question: Does a line tra...

Clinical Question: Does a line transfusion in anemic patients with acute coronary syndrome improve survival?

Setting: Inpatient (any location) with outpatient follow-up

cogitation Design: Cohort (prospective)

Synopsis: Investigators analyzed data from 24112 patients enlisted in three large international trials evaluating various anti-thrombotic regimens in patients with acute coronary syndrome Analysis was limited to patients with full data on transfusion and bleeding casualty All end points were evaluated through persons who were blinded to treatment cluster assignment and who were unaware of whether patients received family transfusions. Because blood transfusion was left to the discretion of the treating physician, associations between transfusion and primary and secondary fall of the curtain points were evaluated using multiple logistic regression to identify independent variables and dominion government for confounding factors.

A total of 2401 patients (10 percent) underwent at least individual blood transfusion during their hospitalization. Transfusion was related independently to an increased risk of death at 30 days (hazard ratio = 394; 95 percent confidence interval, 326 to 475) The predicted probability of death was higher when a transfusion was performed for hematocrit values greater than 25 percent with no benefit or risk exposeed for transfusions given for values lower than 25 percent

A previous trial (Wu WC et al. kindred transfusion in elderly patients with acute myocardial infarction. N Engl J M October 25 2001;345:1230-6) showed a benefit of selective transfusion in somewhat old patients hospitalized with acute coronary syndrome and a hematocrit les than 33 percent forward admission (i.e., not acutely developing during hospitalization).

Bottom Line: progeny transfusion in otherwise stable patients with acute coronary syndrome who bring out anemia during hospitalization may increase mortality risk, especially if the hematocrit plain is higher than 25 percent (Level of Evidence: 2b)

research Reference: Rao SV, et al. Relationship of vital fluid transfusion and clinical outcomes in patients with acute coronary syndrome JAMA October 6 2004;292:1555-62

Used with permission from Slawson D kindred transfusion might increase acute coronary syndrome mortality. Accessed online November 24 2004 at: http://www.InfoPOEMs.com.

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