{"id":27404,"date":"2024-12-16T04:50:00","date_gmt":"2024-12-15T20:50:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27404"},"modified":"2024-12-16T05:49:46","modified_gmt":"2024-12-15T21:49:46","slug":"nejm%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%8a%a8%e8%84%89%e7%98%a4%e6%80%a7%e8%9b%9b%e7%bd%91%e8%86%9c%e4%b8%8b%e8%85%94%e5%87%ba%e8%a1%80%e7%9a%84%e8%87%aa%e7%94%b1%e6%88%96%e9%99%90","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27404","title":{"rendered":"[NEJM\u53d1\u8868\u8bba\u6587]\uff1a\u52a8\u8109\u7624\u6027\u86db\u7f51\u819c\u4e0b\u8154\u51fa\u8840\u7684\u81ea\u7531\u6216\u9650\u5236\u6027\u8f93\u8840\u7b56\u7565"},"content":{"rendered":"\n

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

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage<\/h1>\n\n\n\n

Shane W.\u00a0English,\u00a0Anthony\u00a0Delaney,\u00a0Dean A.\u00a0Fergusson,\u00a0et al<\/h3>\n\n\n\n

N Engl J Med Published\u00a0December 9, 2024<\/strong><\/h3>\n\n\n\n

DOI: 10.1056\/NEJMoa2410962<\/h3>\n\n\n\n

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

BACKGROUND<\/h3>\n\n\n\n

The effect of a liberal red-cell transfusion strategy as compared with a restrictive strategy in patients during the critical care period after an aneurysmal subarachnoid hemorrhage is unclear.<\/p>\n\n\n\n

METHODS<\/h3>\n\n\n\n

We randomly assigned critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia to a liberal strategy (mandatory transfusion at a hemoglobin level of \u226410 g per deciliter) or a restrictive strategy (optional transfusion at a hemoglobin level of \u22648 g per deciliter). The primary outcome was an unfavorable neurologic outcome, defined as a score of 4 or higher on the modified Rankin scale (range, 0 to 6, with higher scores indicating greater disability) at 12 months. Secondary outcomes included 12-month functional independence as assessed with the Functional Independence Measure (FIM; scores range from 18 to 126) and quality of life as assessed with the EuroQol five-dimension, five-level (EQ-5D-5L) utility index (scores range from \u22120.1 to 0.95) and a visual analogue scale (VAS; scores range from 0 to 100); on each assessment, higher scores indicate better health status or quality of life.<\/p>\n\n\n\n

RESULTS<\/h3>\n\n\n\n

A total of 742 patients underwent randomization at 23 centers. The analysis of the primary outcome at 12 months included 725 patients (97.7%). An unfavorable neurologic outcome occurred in 122 of 364 patients (33.5%) in the liberal-strategy group and in 136 of 361 patients (37.7%) in the restrictive-strategy group (risk ratio, 0.88; 95% confidence interval [CI], 0.72 to 1.09; P=0.22). The mean (\u00b1SD) FIM score was 82.8\u00b154.6 in the liberal-strategy group and 79.8\u00b154.5 in the restrictive-strategy group (mean difference, 3.01; 95% CI, \u22125.49 to 11.51). The mean EQ-5D-5L utility index score was 0.5\u00b10.4 in both groups (mean difference, 0.02; 95% CI, \u22120.04 to 0.09). The mean VAS score was 52.1\u00b137.5 in the liberal-strategy group and 50\u00b137.1 in the restrictive-strategy group (mean difference, 2.08; 95% CI, \u22123.76 to 7.93). The incidence of adverse events was similar in the two groups.<\/p>\n\n\n\n

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CONCLUSIONS<\/h3>\n\n\n\n

In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy. (Funded by the Canadian Institutes of Health Research and others; SAHARA ClinicalTrials.gov number, NCT03309579<\/a>.)<\/p>\n","protected":false},"excerpt":{"rendered":"

ORIGINAL ARTICLE Liberal or Restrictive 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\/27404"}],"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=27404"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27404\/revisions"}],"predecessor-version":[{"id":27405,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27404\/revisions\/27405"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27404"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27404"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27404"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}