Neurology in critical care · Transfusion in brain injury
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury
| Design | Phase 3 multicentre randomised clinical trial |
|---|---|
| Treatment | Liberal transfusion strategy, haemoglobin threshold 9 g/dL |
| Control | Restrictive transfusion strategy, threshold 7 g/dL |
| Population | 820 patients with acute brain injury, mean age 51, 45.9% women |
| Follow-up | 180 days |
| Primary endpoint | Unfavourable neurological outcome at 180 days |
| Result | Among 806 patients with primary outcome data — 393 liberal and 413 restrictive — the liberal strategy produced fewer unfavourable neurological outcomes. |
| Secondary endpoints | Mortality, cerebral ischaemic events, transfusion-related complications |
Patients with acute brain injury and anemia randomized to a liberal transfusion strategy were less likely to have an unfavorable neurological outcome than those randomized to a restrictive strategy.
The trial authors, in the published abstract
The odd one out among three transfusion trials in brain injury: TRAIN found benefit where HEMOTION in traumatic brain injury and SAHaRA in subarachnoid haemorrhage found none. Population differences may explain it, or chance may. Practice has not settled.
Taccone FS, Rynkowski CB, Møller K, et al. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. JAMA 2024 Nov 19;332(19):1623-1633.