HEMOTION
Trial question
What is the role of liberal transfusion strategy in critically ill patients with traumatic brain injury and anemia?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
27.0% female
73.0% male
N = 736
736 patients (201 female, 535 male).
Inclusion criteria: adults with moderate or severe traumatic brain injury and anemia.
Key exclusion criteria: receipt of transfusion after ICU admission but before randomization; contraindications or objection to transfusion.
Interventions
N=369 liberal transfusion strategy (triggered by a hemoglobin level ≤ 10 g/dL).
N=367 restrictive transfusion strategy (triggered by a hemoglobin level ≤ 7 g/dL).
Primary outcome
Unfavorable outcome on Glasgow Outcome Scale-Extended at 6 months
68.4%
73.5%
73.5 %
55.1 %
36.8 %
18.4 %
0.0 %
Liberal transfusion
strategy
Restrictive transfusion
strategy
No significant
difference ↔
No significant difference in unfavorable outcome on Glasgow Outcome Scale-Extended at 6 months (68.4% vs. 73.5%; RR 0.93, 95% CI 0.83 to 1.04).
Secondary outcomes
No significant difference in death at 6 months (26.8% vs. 26.3%; HR 1.01, 95% CI 0.76 to 1.35).
Significant increase in median score on Functional Independence Measure (119 points vs. 115 points; MD 4.34, 95% CI 0.22 to 8.45).
Significant increase in median score on EuroQol VAS (70 points vs. 60 points; MD 5.19, 95% CI 0.52 to 9.86).
Safety outcomes
No significant difference in venous thromboembolic events.
Conclusion
In adults with moderate or severe traumatic brain injury and anemia, liberal transfusion strategy was not superior to restrictive transfusion strategy with respect to unfavorable outcome on Glasgow Outcome Scale-Extended at 6 months.
Reference
Alexis F Turgeon, Dean A Fergusson, Lucy Clayton et al. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N Engl J Med. 2024 Aug 22;391(8):722-735.
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