Introduction
Starting the blood supplementation at a higher haemoglobin threshold (Hgb <90-100 g/L) in upper gastrointestinal bleeding (UGIB) can lead to severe consequences due to volume overload. Previous studies have already shown the benefits of restrictive transfusion (Hgb <70-80 g/L). However, the optimal transfusion threshold and how restrictive transfusion affects short- and long-term outcomes after UGIB remained unanswered.
Aims & Methods
We aimed to assess the efficacy and safety of restrictive compared to liberal transfusion strategies in the GIB population, assessing the source of bleeding and transfusion thresholds separately. We searched PubMed, CENTRAL, Embase, and Web of Science for randomised controlled trials on 15.01.2022 without restrictions. Studies comparing lower to higher RBC transfusion thresholds after GIB were eligible. We used the random effect model and calculated pooled mean differences (MD), risk ratios (RR) and proportions with 95% confidence intervals (CI) to calculate the overall effect size.
Results
The search yielded 3955 hits. All seven eligible studies reported on the upper GIB population. Restrictive transfusion did not increase the in-hospital- (RR:0.94; CI:0.46,1.94) and 30-day mortality (RR:0.68; CI:0.48,0.97). In-hospital- and 28 to 45-day rebleeding rate was also not higher with the restrictive modality (RR:0.67; CI:0.30,1.50; RR:0.75; CI:0.49,1.16, respectively). Results of individual studies showed a lower rate of transfusion reactions and post-transfusion intervention if the transfusion was started at a lower threshold. A haemoglobin threshold >80g/L may result in a higher untoward outcome rate.
Conclusion
In summary, restrictive transfusion proved non-inferior to liberal transfusion regarding all investigated clinical endpoints. The optimal restrictive transfusion threshold should be further investigated.
References
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