Potential benefits of restrictive transfusion in upper gastrointestinal bleeding: a systematic review and meta-analysis of randomised controlled trials

The optimal red blood cell (RBC) transfusion strategy in acute gastrointestinal bleeding (GIB) is debated. We aimed to assess the efficacy and safety of restrictive compared to liberal transfusion strategies in the GIB population. We searched PubMed, CENTRAL, Embase, and Web of Science for randomise...

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Published in:Scientific reports 2023-10, Vol.13 (1), p.17301-17301, Article 17301
Main Authors: Teutsch, Brigitta, Veres, Dániel Sándor, Pálinkás, Dániel, Simon, Orsolya Anna, Hegyi, Péter, Erőss, Bálint
Format: Article
Language:English
Subjects:
692/4020
692/4020/1503
692/4020/1503/197
692/4020/1503/197/1546
Bleeding
Blood
Citation management software
Clinical trials
Confidence intervals
Erythrocytes
Gastroenterology
Hemoglobin
Hospitals
Humanities and Social Sciences
Meta-analysis
Mortality
multidisciplinary
Science
Science (multidisciplinary)
Systematic review
Transfusion
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Summary:The optimal red blood cell (RBC) transfusion strategy in acute gastrointestinal bleeding (GIB) is debated. We aimed to assess the efficacy and safety of restrictive compared to liberal transfusion strategies in the GIB population. 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. 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: 0.71; CI 0.35, 1.45). 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 > 80 g/L may result in a higher untoward outcome rate. In summary, restrictive transfusion does not appear to lead to a higher rate of significant clinical endpoints. The optimal restrictive transfusion threshold should be further investigated.
ISSN:2045-2322
2045-2322
DOI:10.1038/s41598-023-44271-8