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Restrictive transfusion strategy improved outcomes in patients with severe upper GI bleeding
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Patients with severe upper GI bleeding had better survival rates and fewer complications with the use of a restrictive approach to transfusion compared with a more liberal strategy in a recent study.
Researchers randomly assigned 461 adult patients with severe acute upper GI bleeding to receive transfusion upon reaching hemoglobin levels below 7 g/dL (restrictive strategy) and 460 patients to receive transfusion upon levels below 9 g/dL (liberal strategy). All-cause mortality rates within 45 days, incidence of further bleeding and other in-hospital complications were determined and compared.
No transfusions were performed in 51% of the restrictive group, compared with 15% in the liberal group (P<.001). Fewer adverse events (40% compared with 48%, P=.02) and lower incidence of further bleeding (10% vs. 16%, P=.01) occurred among the restrictive group. Risk for further bleeding was smaller for the restrictive group (HR=0.68; 95% CI, 0.47-0.98), and fewer patients in that group died of uncontrolled bleeding (0.7% of cases vs. 3.1%; P=.01). Restrictive patients also were less likely to require rescue therapy.
Restrictive group patients had a higher survival rate at 6 weeks (95% of cases vs. 91%), with an adjusted HR of 0.55 (95% CI, 0.33-0.92) for mortality compared with the liberal group. Patients with cirrhosis and Child-Turcotte-Pugh class A or B disease had a significantly greater chance of survival in the restrictive group (HR=0.30; 95% CI, 0.11-0.85); cirrhotic patients with Child-Turcotte-Pugh class C disease did not. Patients with peptic ulcer-related bleeding also had a slightly greater chance of survival using the restrictive strategy (HR=0.70; 95% CI, 0.26-1.25).
“We found that a restrictive transfusion strategy … improved the outcomes among patients with acute upper [GI] bleeding,” the researchers wrote. “The risk of further bleeding, the need for rescue therapy and the rate of complications were all significantly reduced, and the rate of survival was increased. Our results suggest that in patients with acute [GI] bleeding, a strategy of not performing transfusion until the hemoglobin concentration falls below 7 g per deciliter is a safe and effective approach.”
Disclosure: See the study for a full list of relevant disclosures.
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