Restrictive transfusion strategy safe for acute GI bleeding

(HealthDay)—For patients with severe acute gastrointestinal bleeding, a restrictive transfusion approach is safe and effective compared with a liberal approach, according to a study published in the Jan. 2 issue of the New England Journal of Medicine.

Càndid Villanueva, M.D., from the Hospital de Sant Pau in Barcelona, Spain, and colleagues conducted a randomized trial to compare the efficacy and safety of a restrictive transfusion strategy (461 patients; transfusion when hemoglobin level fell below 7 g/dL) with a liberal transfusion strategy (460 patients; transfusion when hemoglobin level fell below 9 g/dL) for severe acute upper gastrointestinal bleeding.

The researchers found that 51 percent in the restrictive-strategy group and 15 percent in the liberal-strategy group did not receive a transfusion (P < 0.001). In the restrictive-strategy group, the probability of survival at six weeks was significantly higher (95 versus 91 percent; hazard ratio for death with restrictive strategy, 0.55). Further bleeding and adverse events occurred in significantly fewer patients in the restrictive-strategy group versus the liberal-strategy group (10 versus 16 percent and 40 versus 48 percent, respectively). For patients who had bleeding associated with a peptic ulcer, the probability of survival was non-significantly increased in the restrictive-strategy group. For patients assigned to the liberal-strategy group, but not the restrictive-strategy, portal-pressure gradient increased significantly within the first five days.

"Our results suggest that, in patients with acute gastrointestinal bleeding, a strategy of not performing transfusion until the hemoglobin concentration falls below 7 g per deciliter is a safe and effective approach," the authors write.