Blood transfusion strategies in patients with cardiovascular disease

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Approximately seven million people in the United Kingdom have cardiovascular disease, and it is a prevalent comorbidity among patients admitted to hospital. In observational studies, anaemia is associated with worse outcomes in patients who have both acute and chronic cardiovascular disease, but it is unclear whether this association is causal or whether correction with red blood cell transfusions modifies this relation.
In this systematic review and meta-analysis, the authors set out to compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery, they did this from published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease.
The authors conclude that the results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold - for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease.