Blood transfusion research set to change the course of practice for heart attack treatment
OTTAWA, November 11, 2023 – Counter to widely adopted blood transfusion strategies in acute care settings, patients with acute myocardial infarction (MI), commonly known as a heart attack, may need a different transfusion strategy, according to new research.
The study, published today in the New England Journal of Medicine, is the result of a multinational trial involving 3,506 participants comparing red blood cell transfusion strategies for patients who had a heart attack and were anemic. While using a restrictive transfusion strategy has been widely adopted in most acute care settings, study findings indicate that patients suffering from heart attack may benefit from a liberal transfusion strategy instead.
Restrictive strategies limit the amount of blood given simply by transfusion at a lower hemoglobin concentration (70 g/L) than liberal strategies, which aim to maintain a concentration higher than 100 g/L.
“Decades worth of research has shown that, for the most part, restrictive strategies decrease blood transfusion by half while not affecting outcomes like mortality within 30 days from transfusion,” said Dr. Paul Hébert, Senior Investigator at the Bruyère Research Institute and Scientist at CHUM Research Centre, referencing the landmark Canadian study that changed blood transfusion practices in critical care worldwide. “Despite this, patients with heart attacks have always been a unique concern. From this study, the evidence is showing us we do need to take special care when treating this population.”
“The results of the MINT trial indicate that a liberal strategy of blood transfusion may improve outcomes in anemic patients with heart attacks without causing undue harm,” said Dr. Jeffrey L. Carson, Distinguished Professor of Medicine at Rutgers Robert Wood Johnson Medical School and the lead investigator of the trial.
Though the current study did not prove definitively that more blood is better, all trends in the data suggest that patients do worse with a restrictive approach to transfusion. This is the first study to date demonstrating harms for patients during blood transfusion in any acute care setting and indicates that patients with a heart attack who are also anemic should get more blood not less because it is likely safer.
“This study’s robust design conducted across multiple countries provides the much-needed evidence to guide clinicians when treating acute myocardial infarction patients with anemia,” said Dean Fergusson, PhD, Senior Scientist and Deputy Scientific Director for Clinical Research at The Ottawa Hospital and Professor at the University of Ottawa.
Restrictive or Liberal Blood Transfusion in Patients with Myocardial Infarction and Anemia was published today in the New England Journal of Medicine.
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Research Communications Manager
Bruyère Research Institute
This research was funded in North America by the National Heart, Lung, and Blood Institute (NHLBI), and Canadian Institutes of Health Research (CIHR) Institute of Circulatory and Respiratory Health.