Expert Panel Recommends Liberal Transfusion Strategy for Hospitalized Patients With AMI

An international panel of experts convened by AABB recommended a liberal red blood cell (RBC) transfusion strategy for hospitalized patients who recently experienced an acute myocardial infarction (AMI) and have a hemoglobin level below 10 g/dL. The conditional recommendation was published yesterday in Annals of Internal Medicine.

The expert panel based its recommendation on a review of four clinical trials involving 4,311 patients and a Cochrane meta-analysis. The panel followed GRADE (Grading of Recommendations Assessment, Development and Evaluation) methods to summarize evidence and formulate recommendations.

The panel found that a liberal strategy provided an estimated 1.2% benefit in 30-day mortality compared with restrictive thresholds, exceeding the panel’s minimum threshold for clinical importance. Patients in the restrictive groups experienced 30-day mortality rates of 93 per 1,000, compared with 81 per 1,000 in the liberal groups.

The panel emphasized that the guideline may not apply to all patients with AMI and that transfusion decisions should be guided by the patient’s clinical context. The authors advised clinicians to personalize transfusion decisions, use informed consent discussions to address risks and adopt patient blood management strategies to reduce anemia risk and limit unnecessary transfusions.

“Transfusion decisions in acute myocardial infarction are never one-size-fits-all,” said Claudia S. Cohn, MD, PhD, AABB’s chief medical officer and an expert panel member. “This guideline encourages clinicians to consider the full clinical context, potential risks and strategies to mitigate adverse events when deciding when to transfuse these patients.”