Which Transfusion Strategy Is Best for Acute Upper Gastrointestinal Bleeding?

The current AABB transfusion guideline recommends restrictive rather than liberal transfusion thresholds for hemodynamically stable hospitalized patients (JW Hosp Med May 14 2012). However, whether this strategy applies to patients with acute gastrointestinal (GI) bleeding is uncertain, because such patients were excluded from studies that support the guideline.

Researchers in Spain randomized 921 patients with acute upper GI bleeding to either a restrictive transfusion strategy (transfuse when hemoglobin drops below 7.0 g/dL with a posttransfusion target of 7.0–9.0 g/dL) or a liberal strategy (transfuse when hemoglobin drops below 9.0 g/dL with a posttransfusion target of 9.0–11.0 g/dL). Etiology of bleeding was peptic ulcers in about 50% o…