In the most recent poll, we asked about transfusion strategies for patients with myocardial infarction and anemia. A total 307 people responded.

The optimal hemoglobin target has varied and is primarily dependent on observational data. The CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA Guidelines?) study found that among patients with hematocrit ≤24%, transfusions were associated with trend toward lower mortality. This and other data have resulted in the current recommendations from the American College of Cardiology and American Heart Association that routine blood transfusion in hemodynamically stable patients with non-ST-segment elevation acute coronary syndrome and hemoglobin levels >8 g/dL is not recommended. The majority of responses to the poll were consistent with these recommendations, with a transfusion targeted to achieving a hemoglobin level >8 g/dl (>8 g/dl selected by 41%; >8.5 g/dl selected by 10%; and >9 g/dL selected by 15%).

In contrast to observational data, randomized data performed in intensive care unit patients using a restrictive strategy of transfusing only patients with a hemoglobin <7 gm/dl (selected by 17% of respondents) had similar outcomes to a more liberal strategy; however, few patients with acute coronary syndromes were included.  Recent data from the trial found results consistent with a more restrictive strategy.¹

References

1. Holcomb JB, Tilley BC, Baraniuk S, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015;313:471-82.

Clinical Topics: Acute Coronary Syndromes

Keywords: Acute Coronary Syndrome, Hematocrit, American Heart Association, Angina, Unstable, Anemia, Myocardial Infarction, Hemoglobins, Blood Transfusion, Intensive Care Units, Risk Assessment

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