WHAT'S NEW: Many reasons to limit transfusions for acute upper GI bleed
This RCT provides evidence that patients with acute UGIB have improved survival rates and fewer adverse events when a restrictive transfusion strategy is used. In addition to improving patient outcomes, a restrictive strategy will likely reduce costs and overall use of blood products. Thus, the study, along with other recent evaluations, adds evidence to support more restrictive transfusion thresholds.
The AABB (formerly named the American Association of Blood Banks) recently
released guidelines calling for restrictive transfusion thresholds (7-8 g/dL) in stable hospitalized patients.7 In 2012, the American College of Gastroenterology published a practice guideline with a recommended target hemoglobin level of ≥7 g/dL in the management of patients who have ulcer bleeding but no signs of intravascular depletion or comorbidities such as coronary artery disease.8
CAVEATS: Results might differ when endoscopy is delayed
The patients in the study detailed here underwent emergency gastroscopy within 6 hours of admission, and both groups received the same therapies based on endoscopic findings. It remains unclear whether the benefits of a restrictive transfusion strategy would persist in patients who do not undergo endoscopy within that timeframe. And, because the reported baseline characteristics of the patients did not include the prevalence of cardiac disease, caution should be exercised before extrapolating these results to patients with underlying (active or historical) cardiac disease.
CHALLENGES TO IMPLEMENTATION: Changing long-held policies may be difficult
Although RCTs as well as clinical guidelines suggest that restrictive transfusion policies are safe and effective, changing long-held clinical practices is never easy.
ACKNOWLEDGEMENT
The PURLs Surveillance System was supported in part by Grant Number UL1RR024999 from the National Center For Research Resources, a Clinical Translational Science Award to the University of Chicago. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.
