A winning strategy for blood transfusions among anemic heart attack patients

Practicing a cautious blood transfusion strategy with anemic myocardial infarction (MI) patients is associated with improved safety and significant cost savings, according to new findings presented at ESC Congress 2020.

The REALITY trial tracked data from 668 MI patients who received care at one of 35 hospitals in France and Spain. All patients were anemic, and they were randomly chosen to be treated with either a restrictive transfusion strategy or a liberal transfusion strategy. With the restrictive strategy, the transfusion was withheld until hemoglobin dropped to 8 g/dL. With the liberal strategy, on the other hand, the transfusion was allowed once hemoglobin hit 10 g/dL or below.

Overall, the two strategies had similar outcomes when it came to preventing major adverse cardiac events after 30 days. The team also found that the restrictive strategy had an 84% chance of saving money, and it made patients “significantly less likely” to develop an infection or acute lung injury.

“Blood is a precious resource, and transfusion is costly, logistically cumbersome, and has side effects,” principal investigator P. Gabriel Steg, MD, of Hospital Bichat in Paris, said in a statement. “The REALITY trial supports the use of a restrictive strategy for blood transfusion in myocardial infarction patients with anemia. The restrictive strategy saves blood, is safe, and is at least as effective in preventing 30-day cardiac events compared to a liberal strategy, while saving money.”

ESC Congress 2020 is completely digital due to the ongoing COVID-19 pandemic. More information from the European Society of Cardiology is available here.