Ann Intern Med

Liberal transfusion strategy recommended for hospitalized patients with acute MI

September 1, 2025

The Association of Blood & Biotherapies' (AABB’s) new international clinical practice guideline recommends a liberal red blood cell transfusion strategy for hospitalized patients with acute MI when hemoglobin falls to <10 g/dL. This is a conditional recommendation based on low-certainty evidence, but it reflects a significant change from the previously favored restrictive threshold of 7 to 8 g/dL, which may be associated with increased mortality in acute MI patients. Transfusion decisions shouldn’t rely solely on hemoglobin levels.

The recommendations are based on a meta-analysis of four randomized trials (including MINT and REALITY), encompassing over 4,300 patients. The liberal strategy showed a 1.2% absolute reduction in 30-day mortality compared with the restrictive approach.

Source:

Pagano MB, et al. (2025, August 19). Ann Intern Med. Red Cell Transfusion in Acute Myocardial Infarction: AABB International Clinical Practice Guidelines. https://pubmed.ncbi.nlm.nih.gov/40825204/