Restrictive Transfusion Strategy Lowers Mortality in Patients with Upper Gastrointestinal Bleeding

Randomized trials in critically ill adults and children have demonstrated better outcomes with a restrictive approach to red-cell transfusion (NEJM JW Gen Med Feb 12 1999 and NEJM JW Pediatr and Adolesc Med Apr 18 2007). However, patients with acute gastrointestinal (GI) bleeding were not included in these studies. Transfusion for massive exsanguination obviously can be lifesaving, but the value of transfusion when lesser amounts of bleeding occur has been unclear — until now.

Spanish investigators randomized 921 patients with nonmassive acute GI bleeding (most with ulcers or esophageal varices) and low risk for rebleeding to either a restrictive or a liberal transfusion strategy (transfusion at hemoglobin level <7 or <9 g/dL, respectively).…