People who have suffered a heart attack and suffer from anemia have a lower risk of recurrence if they receive transfusions to maintain higher hemoglobin levels. The recommendation to transfuse only when hemoglobin is below 7 or 8 g per deciliter has been widely adopted. However, adults who have suffered a heart attack may benefit from a higher hemoglobin level, according to researchers at the University of Pittsburgh.
In their recent work, they sought to provide evidence that could be used to establish transfusion standards for patients who have suffered a heart attack, in order to improve survival rates and reduce the risk of recurrence. For the purposes of the study, the scientists recruited 3,504 people, with an average age of 72, registered in 144 hospitals in six countries.
All the participants had suffered a heart attack and were anemic, with hemoglobin levels of less than 10 g/dL – below the normal range of 12 to 13 g/dL. In the study, half of the volunteers (the liberal group) received blood transfusions to maintain their hemoglobin levels at or above 10 g/dL. The other half (the restrictive group) received transfusions only when their hemoglobin levels fell to 8 g/dL or lower.
According to the results, published in the New England Journal of Medicine, transfusing more red blood cells can improve health outcomes in people with anemia and who have suffered a heart attack “without causing undue harm”. In detail, the team found that the incidence of death or recurrent heart attack was 2.4% lower when a liberal approach was used. The authors stress that more research is needed to ensure that doctors have the best evidence when considering transfusion in patients with anemia who have suffered a heart attack.
This study from the University of Pittsburgh, while not conclusive, raises critical questions about current transfusion practices in heart attack patients with anemia. The findings suggest potential benefits of a liberal transfusion approach, but how might these influence existing guidelines? The reduced recurrence of heart attacks noted in the study is a key observation, but it’s also a reminder that medical science is constantly evolving. As researchers and clinicians ponder over these results, the ultimate goal remains clear: to refine treatment strategies for better patient outcomes. The path forward may not be definitive yet, but the study undoubtedly adds a valuable dimension to our understanding of anemia management in heart attack recovery
Carson, J. L., Brooks, M. M., Hébert, P. C., Goodman, S. G., et al. (2023). Restrictive or liberal transfusion strategy in myocardial infarction and anemia. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2307983
American Heart Association. (2023, November 11). Red blood cell transfusions may improve outcomes in heart attack patients with anemia. American Heart Association Scientific Sessions 2023, Late-Breaking Science Abstract in LBS.02. Retrieved from https://newsroom.heart.org/news/red-blood-cell-transfusions-may-improve-outcomes-in-heart-attack-patients-with-anemia