N Engl J Med

Liberal transfusion strategy offers no significant benefit over restrictive approach in aSAH

December 13, 2024

Study design: The multicenter, randomized SAHARA trial evaluated the efficacy of liberal vs. restrictive RBC transfusion strategies in critically ill patients with aneurysmal subarachnoid hemorrhage (aSAH) and anemia. A total of 742 patients were randomized to receive either a liberal transfusion strategy (transfusion at Hgb levels ≤10 g/dL) or a restrictive strategy (transfusion at Hgb levels ≤8 g/dL). Primary outcome was an unfavorable neurologic outcome at 12 months, defined by a modified Rankin scale score of ≥4.

Results: At 12 months, unfavorable neurologic outcomes occurred in 33.5% of patients in the liberal-strategy group vs. 37.7% in the restrictive-strategy group (P = 0.22). Secondary outcomes, including functional independence and quality of life, showed no significant differences between the groups. Adverse event rates were similar between groups.

Impact on clinical practice: The findings suggest that a liberal transfusion strategy doesn’t confer significant neurologic or functional benefits over a restrictive approach in aSAH patients. Clinicians should consider these results when determining transfusion thresholds, balancing the potential risks and benefits of each strategy.

Source:

English SW, et al; SAHARA Trial Investigators on behalf of the Canadian Critical Care Trials Group. (2024, December 9).N Engl J Med. Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage. https://pubmed.ncbi.nlm.nih.gov/39655786/