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首页> 美国卫生研究院文献>British Medical Journal >Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis
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Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis

机译：在非心脏外科手术中限制性输血策略与常规输血策略对心血管疾病患者预后的影响：系统评价和荟萃分析

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>Objective To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery.>Design Systematic review and meta-analysis.>Data sources Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible.>Trial selection Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease.>Data extraction and synthesis Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios.>Main outcome measures 30 day mortality, and cardiovascular events.>Results 41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I2=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I2=0%).>Conclusions The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or chronic cardiovascular disease. Effects on mortality and other outcomes are uncertain. These data support the use of a more liberal transfusion threshold (>80 g/L) for patients with both acute and chronic cardiovascular disease until adequately powered high quality randomised trials have been undertaken in patients with cardiovascular disease.>Registration PROSPERO CRD42014014251.
机译：>目的，比较未接受心脏手术的心血管疾病患者采用限制性输血策略和常规输血策略的结果。>设计。系统回顾和荟萃分析。>数据来源< / strong>涉及医院红细胞输注阈值的随机对照试验。我们搜索（至2015年11月2日）CENTRAL，Medline，Embase，CINAHL，PubMed，LILACS，NHSBT输血证据库，ClinicalTrials.gov，WHO国际临床试验注册平台，ISRCTN注册和EU临床试验注册。尽可能联系作者以获取数据。>试验选择。比较有限制的输血和有限制的输血阈值（包括心血管疾病患者）的已发表和未发表的随机对照试验。>数据提取和合成一式两份完成提取。使用Cochrane方法评估偏倚风险。在所有荟萃分析中均显示了95％置信区间的相对危险度。使用Mantel-Haenszel随机效应模型汇总风险比率。>主要结局指标 30天死亡率和心血管事件。>结果：确定41项试验；其中，有7项包含心血管疾病患者的数据。作者从另外四项纳入心血管疾病患者的试验中获得了数据。总共纳入了11个纳入研究的心血管疾病患者（n = 3033）的试验以进行荟萃分析（限制性输血，n = 1514例；自由输血，n = 1519）。输血阈值与30天死亡率之间相关性的合并风险比为1.15（95％置信区间0.88至1.50，P = 0.50），异质性很小（I 2 = 14％）。与限制性输注相比，限制性输注治疗的患者发生急性冠脉综合征的风险增加（九项试验；风险比1.78，95％置信区间1.18至2.70，P = 0.01，I 2 = 0％） 。>结论。结果表明，对于正在进行的急性冠脉综合征或慢性心血管疾病的患者，使用低于80 g / L的限制性输注阈值可能并不安全。对死亡率和其他结果的影响尚不确定。这些数据支持对急性和慢性心血管疾病患者使用更为宽松的输血阈值（> 80 g / L），直到对心血管疾病患者进行了充分有力的高质量随机试验为止。>注册 > PROSPERO CRD42014014251。

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