Transfusion Strategies for Acute Upper Gastrointestinal Bleeding

Càndid Villanueva, M.D., Alan Colomo, M.D., Alba Bosch, M.D., Mar Concepción, M.D., Virginia Hernandez-Gea, M.D., Carles Aracil, M.D., Isabel Graupera, M.D., María Poca, M.D., Cristina Alvarez-Urturi, M.D., Jordi Gordillo, M.D., Carlos Guarner-Argente, M.D., Miquel Santaló, M.D., Eduardo Muñiz, M.D., and Carlos Guarner, M.D.

N Engl J Med 2013; 368:11-21January 3, 2013DOI: 10.1056/NEJMoa1211801

Comments open through January 8, 2013

Abstract
Article
References
Citing Articles (1)
Comments (4): Background
The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.
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Methods
We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter). Randomization was stratified according to the presence or absence of liver cirrhosis.
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Results
A total of 225 patients assigned to the restrictive strategy (51%), as compared with 65 assigned to the liberal strategy (15%), did not receive transfusions (P<0 .001="" 0.11="" 0.26="" 0.30="" 0.33="" 0.45="" 0.55="" 0.70="" 0.85="" 0.92="" 1.04="" 1.25="" 10="" 16="" 2.37="" 40="" 48="" 5="" 6="" 91="" 95="" a="" adverse="" and="" as="" assigned="" associated="" at="" b="" bleeding="" but="" c="" child="" ci="" cirrhosis="" class="" compared="" confidence="" days="" death="" disease="" events="" first="" for="" further="" gradient="" group="" had="" hazard="" higher="" in="" increased="" interval="" liberal-strategy="" liberal="" not="" occurred="" of="" or="" p="" patients="" peptic="" portal-pressure="" probability="" ratio="" restrictive-strategy="" restrictive="" significantly="" slightly="" strategy.="" strategy="" subgroup="" survival="" than="" the="" those="" to="" ugh="" ulcer="" vs.="" was="" weeks="" who="" with="" within="">
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Conclusions
As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding. (Funded by Fundació Investigació Sant Pau; ClinicalTrials.gov number, NCT00414713.)
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