Restricting blood transfusion in patients with myocardial infarction and anemia (MINT trial)
In randomized trials totaling over 21,000 patients, restricting red blood cell transfusion until hemoglobin fell below 7 or 8 g/dL in acutely ill, hemodynamically stable patients (as compared to transfusing below 9 or 10 g/dL) resulted in a 50% reduction in blood transfused, without apparent harm.
In critically ill patients, the 1999 TRICC trial established 7 g/dL as a generally accepted threshold for red cell transfusion in most ICU patients.
Above those thresholds, the less blood transfused, the better, it seems.
Controversy has persisted, though, as to ideal transfusion thresholds in patients with cardiovascular disease, particularly active myocardial ischemia. Does increasing oxygen delivery to ischemic myocardium outweigh any harms of volume loading and immunogenicity from the transfused blood? Three randomized trials showed inconsistent results; the largest suggested restricting transfusion to Hb<8 g/dL in acute MI appeared safe, but that non-inferiority trial with a wide confide…
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