{"id":25052,"date":"2023-11-17T04:58:00","date_gmt":"2023-11-16T20:58:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25052"},"modified":"2023-11-17T06:16:00","modified_gmt":"2023-11-16T22:16:00","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%bf%83%e6%a2%97%e4%bc%b4%e8%b4%ab%e8%a1%80%e6%82%a3%e8%80%85%e7%9a%84%e9%99%90%e5%88%b6%e4%b8%8e%e8%87%aa%e7%94%b1%e8%be%93%e8%a1%80%e7%ad%96","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25052","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u5fc3\u6897\u4f34\u8d2b\u8840\u60a3\u8005\u7684\u9650\u5236\u4e0e\u81ea\u7531\u8f93\u8840\u7b56\u7565"},"content":{"rendered":"\n

ORIGINAL ARTICLE<\/a><\/p>\n\n\n\n

Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia<\/h1>\n\n\n\n

Jeffrey L. Carson, Maria Mori Brooks, Paul C. H\u00e9bert, et al<\/h3>\n\n\n\n

N Engl J Med November 11, 2023
DOI: 10.1056\/NEJMoa2307983<\/h3>\n\n\n\n

Abstract<\/h2>\n\n\n\n

BACKGROUND<\/h2>\n\n\n\n

A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level.<\/p>\n\n\n\n

METHODS<\/h2>\n\n\n\n

In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days.<\/p>\n\n\n\n

RESULTS<\/h2>\n\n\n\n

A total of 3504 patients were included in the primary analysis. The mean (\u00b1SD) number of red-cell units that were transfused was 0.7\u00b11.6 in the restrictive-strategy group and 2.5\u00b12.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P=0.07). Death occurred in 9.9% of the patients with the restrictive strategyand in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49).<\/p>\n\n\n\n

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CONCLUSIONS<\/h2>\n\n\n\n

In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407. opens in new tab<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Restrictive or Liberal Transfusion Str […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25052"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25052"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25052\/revisions"}],"predecessor-version":[{"id":25053,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25052\/revisions\/25053"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25052"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25052"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25052"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}