Restrictive Vs Liberal Transfusion for Upper Gastrointestinal Bleeding: a Meta-analysis of Randomized Controlled Trials

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2013 Nov 5

PMID 24187470

Citations 13

Authors

Juan Wang

Yong-Xin Bao

Ming Bai

Yong-Guo Zhang

Wen-Da Xu

Xing-Shun Qi

Affiliations

Soon will be listed here.

Abstract

Aim: To compare the outcome of upper gastrointestinal bleeding (UGIB) between patients receiving restrictive and liberal transfusion.

Methods: PubMed, EMBASE, and Cochrane Library databases were employed to identify all relevant randomized controlled trials regarding the outcome of UGIB after restrictive or liberal transfusion. Primary outcomes were death and rebleeding. Secondary outcomes were length of hospitalization, amount of blood transfused, and hematocrit and hemoglobin at discharge or after expansion.

Results: Overall, 4 papers were included in this meta-analysis. The incidence of death was significantly lower in patients receiving restrictive transfusion than those receiving liberal transfusion (OR: 0.52, 95%CI: 0.31-0.87, P = 0.01). The incidence of rebleeding was lower in patients receiving restrictive transfusion than those receiving liberal transfusion, but this difference did not reach any statistical significance (OR: 0.26, 95%CI: 0.03-2.10, P = 0.21). Compared with those receiving liberal transfusion, patients receiving restrictive transfusion had a significantly shorter length of hospitalization (standard mean difference: -0.17, 95%CI: -0.30--0.04, P = 0.009) and a significantly smaller amount of blood transfused (standard mean difference: -0.74, 95%CI: -1.15--0.32, P = 0.0005) with a lower hematocrit and hemoglobin level at discharge or after expansion.

Conclusion: Restrictive transfusion should be employed in patients with UGIB.

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References

Jairath V, Hearnshaw S, Brunskill S, Doree C, Hopewell S, Hyde C . Red cell transfusion for the management of upper gastrointestinal haemorrhage. Cochrane Database Syst Rev. 2010; (9):CD006613. DOI: 10.1002/14651858.CD006613.pub3. View

Jadad A, Moore R, Carroll D, Jenkinson C, Reynolds D, Gavaghan D . Assessing the quality of reports of randomized clinical trials: is blinding necessary?. Control Clin Trials. 1996; 17(1):1-12. DOI: 10.1016/0197-2456(95)00134-4. View

Barkun A, Bardou M, Kuipers E, Sung J, Hunt R, Martel M . International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010; 152(2):101-13. DOI: 10.7326/0003-4819-152-2-201001190-00009. View

De Franchis R . Revising consensus in portal hypertension: report of the Baveno V consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2010; 53(4):762-8. DOI: 10.1016/j.jhep.2010.06.004. View

Blair S, Janvrin S, McCollum C, Greenhalgh R . Effect of early blood transfusion on gastrointestinal haemorrhage. Br J Surg. 1986; 73(10):783-5. DOI: 10.1002/bjs.1800731007. View

Hearnshaw S, Logan R, Palmer K, Card T, Travis S, Murphy M . Outcomes following early red blood cell transfusion in acute upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2010; 32(2):215-24. DOI: 10.1111/j.1365-2036.2010.04348.x. View

Gralnek I, Barkun A, Bardou M . Management of acute bleeding from a peptic ulcer. N Engl J Med. 2008; 359(9):928-37. DOI: 10.1056/NEJMra0706113. View

Villarejo F, Rizzolo M, Lopez E, Domeniconi G, Arto G, Apezteguia C . [Acute anemia in high digestive hemorrhage. Margins of security for their handling without transfusion of red globules]. Acta Gastroenterol Latinoam. 1999; 29(4):261-70. View

Sung J, Tsoi K, Ma T, Yung M, Lau J, Chiu P . Causes of mortality in patients with peptic ulcer bleeding: a prospective cohort study of 10,428 cases. Am J Gastroenterol. 2009; 105(1):84-9. DOI: 10.1038/ajg.2009.507. View

10.

Dellinger R, Levy M, Carlet J, Bion J, Parker M, Jaeschke R . Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2007; 36(1):296-327. DOI: 10.1097/01.CCM.0000298158.12101.41. View

11.

Moher D, Pham B, Jones A, Cook D, Jadad A, Moher M . Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?. Lancet. 1998; 352(9128):609-13. DOI: 10.1016/S0140-6736(98)01085-X. View

12.

Hebert P, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G . A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999; 340(6):409-17. DOI: 10.1056/NEJM199902113400601. View

13.

Mantel N, Haenszel W . Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959; 22(4):719-48. View

14.

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

15.

Moher D, Liberati A, Tetzlaff J, Altman D . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009; 151(4):264-9, W64. DOI: 10.7326/0003-4819-151-4-200908180-00135. View

16.

Laine L, Yang H, Chang S, Datto C . Trends for incidence of hospitalization and death due to GI complications in the United States from 2001 to 2009. Am J Gastroenterol. 2012; 107(8):1190-5. DOI: 10.1038/ajg.2012.168. View

17.

Lacroix J, Hebert P, Hutchison J, Hume H, Tucci M, Ducruet T . Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. 2007; 356(16):1609-19. DOI: 10.1056/NEJMoa066240. View

18.

Restellini S, Kherad O, Jairath V, Martel M, Barkun A . Red blood cell transfusion is associated with increased rebleeding in patients with nonvariceal upper gastrointestinal bleeding. Aliment Pharmacol Ther. 2012; 37(3):316-22. DOI: 10.1111/apt.12170. View

19.

Hearnshaw S, Brunskill S, Doree C, Hyde C, Travis S, Murphy M . Red cell transfusion for the management of upper gastrointestinal haemorrhage. Cochrane Database Syst Rev. 2009; (2):CD006613. DOI: 10.1002/14651858.CD006613.pub2. View

20.

Elizalde J, Moitinho E, Garcia-Pagan J, Cirera I, Escorsell A, Bandi J . Effects of increasing blood hemoglobin levels on systemic hemodynamics of acutely anemic cirrhotic patients. J Hepatol. 1998; 29(5):789-95. DOI: 10.1016/s0168-8278(98)80260-2. View