viernes, 22 de febrero de 2013

Transfusion Strategies for Acute Upper Gastrointestinal Bleeding — NEJM

Transfusion Strategies for Acute Upper Gastrointestinal Bleeding — NEJM

Original Article

Transfusion Strategies for Acute Upper Gastrointestinal Bleeding

Càndid Villanueva, M.D., Alan Colomo, M.D., Alba Bosch, M.D., Mar Concepción, M.D., Virginia Hernandez-Gea, M.D., Carles Aracil, M.D., Isabel Graupera, M.D., María Poca, M.D., Cristina Alvarez-Urturi, M.D., Jordi Gordillo, M.D., Carlos Guarner-Argente, M.D., Miquel Santaló, M.D., Eduardo Muñiz, M.D., and Carlos Guarner, M.D.
N Engl J Med 2013; 368:11-21January 3, 2013DOI: 10.1056/NEJMoa1211801
Comments open through January 8, 2013
Citing Articles (1)
Comments (4)


The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. We compared the efficacy and safety of a restrictive transfusion strategy with those of a liberal transfusion strategy.


We enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly assigned 461 of them to a restrictive strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion when the hemoglobin fell below 9 g per deciliter). Randomization was stratified according to the presence or absence of liver cirrhosis.


A total of 225 patients assigned to the restrictive strategy (51%), as compared with 65 assigned to the liberal strategy (15%), did not receive transfusions (P<0 .001="" 0.11="" 0.26="" 0.30="" 0.33="" 0.45="" 0.55="" 0.70="" 0.85="" 0.92="" 1.04="" 1.25="" 10="" 16="" 2.37="" 40="" 48="" 5="" 6="" 91="" 95="" a="" adverse="" and="" as="" assigned="" associated="" at="" b="" bleeding="" but="" c="" child="" ci="" cirrhosis="" class="" compared="" confidence="" days="" death="" disease="" events="" first="" for="" further="" gradient="" group="" had="" hazard="" higher="" in="" increased="" interval="" liberal-strategy="" liberal="" not="" occurred="" of="" or="" p="" patients="" peptic="" portal-pressure="" probability="" ratio="" restrictive-strategy="" restrictive="" significantly="" slightly="" strategy.="" strategy="" subgroup="" survival="" than="" the="" those="" to="" ugh="" ulcer="" vs.="" was="" weeks="" who="" with="" within="">


As compared with a liberal transfusion strategy, a restrictive strategy significantly improved outcomes in patients with acute upper gastrointestinal bleeding. (Funded by Fundació Investigació Sant Pau; number, NCT00414713.)

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