Neurology in critical care · Transfusion in brain injury
Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage
| Design | Multicentre randomised controlled trial at 23 centres |
|---|---|
| Treatment | Liberal transfusion strategy |
| Control | Restrictive transfusion strategy |
| Population | 742 patients with aneurysmal subarachnoid haemorrhage and anaemia |
| Follow-up | 12 months |
| Primary endpoint | Unfavourable neurological outcome at 12 months |
| Result | Among 725 patients (97.7%) with primary outcome data, unfavourable neurological outcome occurred in 122 of 364 (33.5%) in one group, with no significant advantage to the liberal strategy. |
| Secondary endpoints | Mortality, functional outcome, delayed cerebral ischaemia |
In patients with aneurysmal subarachnoid hemorrhage and anemia, a liberal transfusion strategy did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy.
The trial authors, in the published abstract
Concordant with HEMOTION and discordant with TRAIN. Two of the three brain-injury transfusion trials are negative, which is where the weight of evidence currently sits.
English SW, Delaney A, Fergusson DA, et al. Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage. N Engl J Med 2025 Mar 13;392(11):1079-1088.