Neurology in critical care · Transfusion in brain injury
Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Liberal transfusion strategy, haemoglobin threshold 10 g/dL |
| Control | Restrictive transfusion strategy, threshold 7 g/dL |
| Population | 742 critically ill patients with traumatic brain injury and anaemia, 371 per group |
| Follow-up | 6 months |
| Primary endpoint | Unfavourable neurological outcome at 6 months, Glasgow Outcome Scale Extended 1 to 5 |
| Result | Median haemoglobin in intensive care was 10.8 g/dL in the liberal group. A liberal strategy did not reduce the risk of unfavourable neurological outcome at 6 months among the 722 patients analysed. |
| Secondary endpoints | Mortality, functional independence, quality of life, transfusion reactions |
In critically ill patients with traumatic brain injury and anemia, a liberal transfusion strategy did not reduce the risk of an unfavorable neurologic outcome at 6 months.
The trial authors, in the published abstract
Directly contradicts TRAIN, published months apart on an overlapping question. Where two well-conducted trials disagree, the honest position is that the threshold is not established, and 7 g/dL remains defensible.
Turgeon AF, Fergusson DA, Clayton L, et al. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N Engl J Med 2024 Aug 22;391(8):722-735.