Cortés-Puch I, Wiley B M, Sun J, Klein H G, Welsh J, Danner R L, Eichacker P Q, Natanson C
Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
Transfus Med. 2018 Oct;28(5):335-345. doi: 10.1111/tme.12535. Epub 2018 Apr 19.
To evaluate the risks of restrictive red blood cell transfusion strategies (haemoglobin 7-8 g dL ) in patients with and without known cardiovascular disease (CVD).
Recent guidelines recommend restrictive strategies for CVD patients hospitalised for non-CVD indications, patients without known CVD and patients hospitalised for CVD corrective procedures.
METHODS/MATERIALS: Database searches were conducted through December 2017 for randomised clinical trials that enrolled patients with and without known CVD, hospitalised either for CVD-corrective procedures or non-cardiac indications, comparing effects of liberal with restrictive strategies on major adverse coronary events (MACE) and death.
In CVD patients not undergoing cardiac interventions, a liberal strategy decreased (P = 0·01) the relative risk (95% CI) (RR) of MACE [0·50 (0·29-0·86)] (I = 0%). Among patients without known CVD, the incidence of MACE was lower (1·7 vs 3·9%), and the effect of a liberal strategy on MACE [0·79, (0·39-1·58)] was smaller and non-significant but not different from CVD patients (P = 0·30). Combining all CVD and non-CVD patients, a liberal strategy decreased MACE [0·59, (0·39-0·91); P = 0·02]. Conversely, among studies reporting mortality, a liberal strategy decreased mortality in CVD patients (11·7% vs·13·3%) but increased mortality (19·2% vs 18·0%) in patients without known CVD [interaction P = 0·05; ratio of RR 0·73, (0·53-1·00)]. A liberal strategy also did not benefit patients undergoing cardiac surgery; data were insufficient for percutaneous cardiac procedures.
In patients hospitalised for non-cardiac indications, liberal transfusion strategies are associated with a decreased risk of MACE in both those with and without known CVD. However, this only provides a survival benefit to CVD patients not admitted for CVD-corrective procedures.
评估已知患有心血管疾病（CVD）和未患心血管疾病的患者采用限制性红细胞输血策略（血红蛋白7 - 8 g/dL）的风险。
近期指南建议，对于因非心血管疾病适应症住院的心血管疾病患者、无已知心血管疾病的患者以及因心血管疾病矫正手术住院的患者，采用限制性输血策略。
方法/材料：检索截至2017年12月的数据库，查找纳入已知患有心血管疾病和未患心血管疾病患者的随机临床试验，这些患者因心血管疾病矫正手术或非心脏适应症住院，比较宽松输血策略与限制性输血策略对主要不良冠状动脉事件（MACE）和死亡的影响。
在未接受心脏干预的心血管疾病患者中，宽松输血策略降低了（P = 0.01）MACE的相对风险（95%CI）（RR）[0.50（0.29 - 0.86）]（I² = 0%）。在无已知心血管疾病的患者中，MACE的发生率较低（1.7%对3.9%），宽松输血策略对MACE的影响[0.79，（0.39 - 1.58）]较小且无统计学意义，但与心血管疾病患者无差异（P = 0.30）。将所有心血管疾病和非心血管疾病患者合并分析，宽松输血策略降低了MACE[0.59，（0.39 - 0.91）；P = 0.02]。相反，在报告死亡率的研究中，宽松输血策略降低了心血管疾病患者的死亡率（11.7%对13.3%），但增加了无已知心血管疾病患者的死亡率（19.2%对18.0%）[交互作用P = 0.05；RR比值0.73，（0.53 - 1.00）]。宽松输血策略对接受心脏手术的患者也无益处；经皮心脏手术的数据不足。
在因非心脏适应症住院的患者中，宽松输血策略与已知患有心血管疾病和未患心血管疾病的患者MACE风险降低相关。然而，这仅为未因心血管疾病矫正手术入院的心血管疾病患者带来生存益处。
