Liberal Versus Restrictive Transfusion Strategy in Traumatic Brain Injury: An Updated Meta-analysis
Eshita Sharma1, Mrinal Murali Krishna3, Meghna Joseph3, Vinicius Pereira4, Chidubem Ezenna5, Julyana Dantas6, Mithun Murali Krishna7, Isaac Yang2
1David Geffen School of Medicine at University of California, Los Angeles, 2Department of Neurosurgery, David Geffen School of Medicine at University of California, Los Angeles, 3Medical College Thiruvananthapuram, 4Universidad Austral, 5University of Massachusetts – Baystate Medical Center, 6Lahey Hospital & Medical Center, 7Pushpagiri Institute of Medical Sciences
Objective:

To find the optimal transfusion strategy for patients with traumatic brain injury (TBI) and concomitant anemia.

Background:

Anemia is common in TBI and increases the risk of worsening cerebral ischemia. The optimal transfusion strategy for patients with TBI is still unclear.

Design/Methods:

We systematically searched the PubMed, Scopus, and Cochrane Central databases for studies comparing transfusion initiated at hemoglobin levels of ≤ 10 g/dL (liberal) and ≤ 7 g/dL (restrictive). Statistical analysis was performed using R software and followed PRISMA guidelines.

Results:

We included 1,047 patients from 4 RCTs, where 50.52% of patients received a liberal transfusion. Unfavorable GOS (RR 0.98; 95%CI 0.80-1.20; p=0.82), ICU mortality (RR 0.75; 95%CI 0.30-1.88; p=0.53), in-hospital mortality (RR 0.82; 95%CI 0.42-1.61; p=0.56), mortality at 6 months (RR 1.01; 95%CI 0.81-1.26; p=0.92), stroke (RR 1.84; 95%CI 0.65-5.22; p=0.25), MI (RR 0.51; 95%CI 0.09-2.94; p=0.45), ARDS (RR 1.89; 95%CI 0.95-3.75; p=0.06), pneumonia (RR 1.08; 95%CI 0.89-1.30; p=0.45), DVT (RR 1.60; 95%CI 0.78-3.29; p=0.20), pulmonary embolism (RR 1.54; 95%CI0.66-3.59; p=0.31), CNS infection (RR 0.84; 95%CI 0.44-1.62; p=0.60), bacteremia (RR 0.88; 95%CI 0.54-1.43; p=0.59), sepsis/septic shock (RR 0.73; 95%CI 0.47-1.13; p=0.15), seizure (RR 1.21; 95%CI 0.74-1.98; p=0.45), hospital LOS (MD -2.30; 95%CI -15.07-10.47; p=0.72), ICU stay (MD -0.41; 95%CI -7.62-6.80; p=0.91), and surgical site infection (RR 0.72; 95%CI 0.29-1.78; p=0.48) were comparable between both strategies.


Conclusions:

Liberal and restrictive transfusion was comparable in critically ill patients with TBI.

10.1212/WNL.0000000000208447
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