Results Mixed for Liberal Transfusions in Heart Disease
Outcome effects of aggressive protocols in heart disease patients with anemia mixed
WEDNESDAY, Dec. 4, 2013 (HealthDay News) -- The effects of liberal transfusion protocols on outcomes in heart disease patients with anemia are mixed, according to a review published in the Dec. 3 issue of the Annals of Internal Medicine.
Devan Kansagara, M.D., from Portland Veterans Affairs Medical Center in Oregon, and colleagues conducted a systematic literature review to identify trials of blood transfusions, iron, or erythropoiesis-stimulating agents in adults with anemia and congestive heart failure or coronary heart disease. Observational studies of transfusion were also assessed.
The researchers found that liberal transfusion protocols do not improve short-term mortality rates compared with less aggressive protocols (combined relative risk among trials, 0.94; 95 percent confidence interval, 0.61 to 1.42), based on low-strength evidence in six trials and 26 observational studies. However, in a small trial of patients with acute coronary syndrome, decreased mortality rates were seen with liberal transfusion (1.8 versus 13.0 percent; P = 0.032). Three trials with moderate evidence showed intravenous iron improved short-term exercise tolerance and quality of life in patients with heart failure. Seventeen trials of erythropoiesis-stimulating agent therapy with moderate- to high-strength evidence found no consistent benefits and that the therapy may even be associated with harms such as venous thromboembolism.
"Higher transfusion thresholds do not consistently improve mortality rates, but large trials are needed," the authors conclude.