Restrictive versus liberal transfusion strategy for red blood cell transfusion in critically ill patients and in patients with acute coronary syndrome: a systematic review, meta-analysis and trial sequential analysis

摘要: Introduction The risks and benefits of transfusing critically ill patients continue to evoke controversy. Specifically, the with active ischemic cardiac disease represent a "gray area" in literature. Evidence acquisition Meta-analysis effects lower versus higher hemoglobin thresholds on mortality was carried out using PRISMA methodology. A systematic research performed PubMed, Embase, Cochrane Library (last update, December 2014). Inclusion criteria Anemic adult admitted intensive care units and/or anemic acute coronary syndrome which restrictive vs. liberal transfusion therapy compared. Primary endpoint mortality. Included studies were subjected quantifiable analysis, predefined subgroup trial sequential analysis sensitivity analysis. synthesis Thirty RCT's initially identified; 6 fulfilled inclusion criteria, including 2156. There no differences between groups (RR: 0.86, 95% CI 0.70-1.05 P=0.14), neither chronic cardiovascular 1.13, IC 0.88-1.46 P=0.34). However, there is trend towards decreased 0.73-1.01 P=0.06); while myocardial infarct seems like it might be non-significant increased 3.85, 0.82-18.0 P=0.09). Conclusions Restrictive strategy at least as effective patients. Nevertheless, insufficient evidence recommend for syndrome.