Transfusionsstrategiers indflydelse ved subaraknoid blødning
En nylig undersøgelse sammenlignede liberal og restriktiv transfusionsstrategi hos patienter med subaraknoid blødning (SAH) for at vurdere deres indflydelse på neurologiske udfald. Resultaterne viste, at den liberale strategi ikke førte til lavere risiko for ugunstige udfald sammenlignet med den restriktive strategi, men var forbundet med en signifikant lavere risiko for cerebral iskæmi [source_link].
Studiet var en præ-planlagt sekundær analyse af “TRansfusion Strategies in Acute brain INjured Patients” (TRAIN) studiet. Det inkluderede SAH-patienter, der var blevet randomiseret til at modtage røde blodlegemer (RBCT), når Hb-niveauet faldt under 9 g/dL (liberal gruppe) eller 7 g/dL (restriktiv gruppe). I alt deltog 190 SAH-patienter, hvoraf 188 havde data tilgængelige for primært udkomme, som blev defineret som en Glasgow Outcome Scale Extended score på 1-5 ved 180 dage.
Det primære endepunkt var ugunstige neurologiske udfald ved 180 dage. Sekundære endepunkter omfattede hæmoglobinniveauer og forekomsten af cerebral iskæmi. Data blev analyseret ved hjælp af risiko-ratio (RR) og konfidensintervaller (CI) for at vurdere sammenhængen mellem transfusionsstrategien og udfaldet. Resultaterne viste, at 66,3% af patienterne i den liberale gruppe havde ugunstige udfald, sammenlignet med 76,4% i den restriktive gruppe, hvilket indikerer en RR på 0,87. Desuden var randomisering til den liberale gruppe forbundet med en lavere risiko for ugunstige udfald i multivariat analyse (RR 0,83).
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### Article Information
**Title**: Optimal Hemoglobin Threshold for Red Blood Cell Transfusions in Subarachnoid Hemorrhage: A Secondary Analysis of the TRAIN Study
**Authors**:
– Chahnez Taleb
– Elisa Gouvea Bogossian
– Carla Bittencour Rynkowski
– Kirsten Møller
– Piet Lormans
– Manuel Quintana Diaz
– Anselmo Caricato
– Luigi Zattera
– Pedro Kurtz
– Geert Meyfroidt
– Herve Quintard
– Maria Celeste Dias
– Angelo Giacomucci
– Charlotte Castelain
– Russell Chabanne
– Pilar Marcos-Neira
– Stepani Bendel
– Ahmed Subhy Alsheikhly
– Mohamed Elbahnasawy
– Samuel Gay
– Maximilian D’Onofrio
– Konstantin A Popugaev
– Nikolaos Markou
– Pierre Bouzat
– Jean-Louis Vincent
– Fabio Silvio Taccone
**Affiliations**:
1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
2. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
3. Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil.
4. Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
5. Department of Neuroanaesthesiology, Rigshospitalet – University of Copenhagen, Copenhagen, Denmark.
6. Department of Clinical Medicine-Anesthesiology, University of Copenhagen, Copenhagen, Denmark.
7. Department of Intensive Care, AZ Delta, Roeselaere, Belgium.
8. Hospital Universitario de La Paz, Madrid, Spain.
9. Institute of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
10. Department of Anesthesiology and Intensive Care, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
11. DOr Institute of Research and Education, Rio de Janeiro, Brazil.
12. Neurointensive Care, Instituto Estadual do Cerebro Paulo Niemeyer, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
13. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
14. Division of Intensive Care Medicine, Geneva University Hospital, Geneva, Switzerland.
15. Neurocritical Care Unit, Medical University Center (CUME), Porto, Portugal.
16. Anestesia and Intensive Care, Azienda Ospedaliera di Perugia, Italy.
17. Department of Anesthesia and Intensive Care Medicine, AZ Groeninge, Kortrijk, Belgium.
18. Neurocritical Care Unit, University Hospital of Clermont-Ferrand, France.
19. Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
20. Kuopio University Hospital, Kuopio, Finland.
21. Hamad Medical Corporation / Weill Cornell Medicine – Qatar, Doha, Qatar.
22. Tanta University Hospital, Tanta, El Gharbeya, Egypt.
23. Centre Hospitalier Annecy-Genevois, France.
24. Artemidis Zatti Hospital, Viedma, Rio Negro, Argentina.
25. Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia.
26. Burnasyan Federal Medical Biophysical Center, Moscow, Russia.
27. General Hospital of Eleusis Thriasion, Magoula, Greece.
28. Inserm, U1216, CHU Grenoble Alpes, Grenoble, France.
**Publication Details**:
– **Journal**: Critical Care
– **Date**: February 7, 2025
– **Volume**: 29(1):67
– **DOI**: [10.1186/s13054-025-05270-5](https://doi.org/10.1186/s13054-025-05270-5)
**PMID**: 39920710
**PMCID**: PMC11803982
### Abstract Summary
**Background**: The study investigates the optimal hemoglobin (Hb) threshold for triggering red blood cell transfusions (RBCT) in patients with subarachnoid hemorrhage (SAH).
**Methods**: This is a secondary analysis of the “TRansfusion Strategies in Acute brain INjured Patients” (TRAIN) study, comparing patients randomized to liberal (Hb < 9 g/dL) vs. restrictive (Hb < 7 g/dL) transfusion strategies.
**Results**: Among the 190 SAH patients, 188 had available data. The liberal group had a higher age and received more RBCT. At 180 days, 66.3% of the liberal group and 76.4% of the restrictive group had unfavorable outcomes. The liberal group had a lower incidence of cerebral ischemia, and multivariate analysis indicated a lower risk of unfavorable outcomes with liberal strategy.
**Conclusions**: A liberal transfusion strategy did not lead to a lower incidence of unfavorable outcomes compared to a restrictive strategy. However, it was associated with lower risks of cerebral ischemia.
**Trial Registration**: ClinicalTrials.gov number NCT02968654.
### Keywords
– Acute brain injury
– Anemia
– Blood
– Stroke
—
You can use this structured information to fill in any required documentation or databases related to the study.
### Transfusionsstrategiers Indflydelse ved Subaraknoid Blødning
Subaraknoid blødning (SAB) er en alvorlig neurologisk tilstand, der opstår, når der er blødning i det subaraknoide rum, som er det område mellem hjernen og den membran, der dækker hjernen. Denne tilstand kan have fatale konsekvenser, og hurtig behandling er afgørende for patientens overlevelse og bedring. En central del af behandlingen involverer blodtransfusioner, som kan have en betydelig indflydelse på patientens outcome. I denne artikel vil vi undersøge, hvordan transfusionsstrategier kan påvirke forløbet og resultaterne ved subaraknoid blødning.
#### Betydningen af Transfusioner
Blodtransfusioner anvendes ofte i forbindelse med subaraknoid blødning for at håndtere de komplikationer, der kan opstå, herunder hypovolæmisk chok og koagulationsforstyrrelser. Transfusioner kan hjælpe med at stabilisere blodtrykket, forbedre iltforsyningen til hjernen og reducere risikoen for yderligere neurologiske skader.
Der er forskellige typer transfusioner, der kan anvendes, herunder:
1. **Røde blodlegemer (RBCs)**: Anvendes til at øge hæmoglobinniveauet og forbedre ilttransporten i blodet.
2. **Plasma**: Anvendes til at forbedre koagulation og reducere risikoen for blødning.
3. **Trombocytter**: Anvendes til at forhindre blødning hos patienter med lav trombocyttal.
#### Transfusionsstrategier
Transfusionsstrategier henviser til de metoder og retningslinjer, der anvendes til at afgøre, hvornår og hvordan transfusioner skal gives. Faktorer, der påvirker transfusionsstrategier ved subaraknoid blødning, inkluderer:
– **Patientens kliniske tilstand**: Sværhedsgraden af blødningen og patientens hæmodynamiske stabilitet er afgørende for beslutningen om transfusion.
– **Laboratorieresultater**: Hæmoglobin- og trombocyttal samt koagulationsprofiler spiller en vigtig rolle i vurderingen af behovet for transfusion.
– **Tidsramme**: Hurtig intervention er afgørende, og beslutningen om transfusion skal træffes hurtigt for at minimere neurologisk skade.
#### Evidens og Forskning
Forskning har vist, at transfusionsstrategier har en direkte indflydelse på patientens outcome efter subaraknoid blødning. Studier har indikeret, at tidlig transfusion af røde blodlegemer kan forbedre overlevelsesraterne og reducere risikoen for neurologiske komplikationer. Desuden kan en målrettet tilgang til transfusion af plasma og trombocytter være afgørende for at opretholde koagulation og forhindre yderligere blødninger.
En systematisk gennemgang af eksisterende litteratur viser, at en individualiseret transfusionsstrategi, der tager højde for patientens specifikke behov og tilstand, kan føre til bedre resultater. Det er vigtigt, at sundhedspersonale er opdateret om de nyeste retningslinjer og evidensbaserede praksisser for at kunne træffe informerede beslutninger.
#### Konklusion
Transfusionsstrategiers indflydelse ved subaraknoid blødning er en vigtig faktor, der kan påvirke patientens outcome og livskvalitet. Gennem en målrettet og evidensbaseret tilgang kan sundhedspersonale forbedre håndteringen af denne alvorlige tilstand og reducere risikoen for komplikationer. Yderligere forskning er nødvendig for at optimere transfusionsstrategier og sikre den bedst mulige pleje for patienter med subaraknoid blødning. Det er essentielt, at behandlingen tilpasses den enkelte patients behov for at opnå de bedste resultater.
**Citation:**
Crit Care. 2025 Feb 7;29(1):67.
doi: 10.1186/s13054-025-05270-5.
**Authors:**
Chahnez Taleb#, 1
Elisa Gouvea Bogossian#, 2
Carla Bittencour Rynkowski, 3, 4
Kirsten Møller, 5, 6
Piet Lormans, 7
Manuel Quintana Diaz, 8
Anselmo Caricato, 9
Luigi Zattera, 10
Pedro Kurtz, 11, 12
Geert Meyfroidt, 13
Herve Quintard, 14
Maria Celeste Dias, 15
Angelo Giacomucci, 16
Charlotte Castelain, 17
Russell Chabanne, 18
Pilar Marcos-Neira, 19
Stepani Bendel, 20
Ahmed Subhy Alsheikhly, 21
Mohamed Elbahnasawy, 22
Samuel Gay, 23
Maximilian D'Onofrio, 24
Konstantin A Popugaev, 25, 26
Nikolaos Markou, 27
Pierre Bouzat, 28
Jean-Louis Vincent, 1
Fabio Silvio Taccone, 1
*TRAIN Study Trial Group*
**Collaborators:**
TRAIN Study Trial Group:
Marco Antonio Cardoso Ferreira, Rafael Badenes, Christian Baastrup Sondergaard, Kirsten Colpaert, Leticia Petterson, Claudia Díaz, Andrés Saravia, Ahmad Bayrlee, Laura Nedolast, Hussam Elkambergy, Haamid Siddique, Jihad Mallat, Nahla AlJaberi, Samer Shoshan, Ayo Mandi, Bruno De Oliveira, Malligere Prasanna, Rehan Haque, Dnyaneshwar Munde, Sara Chaffee, Fatma Alawadhi, Jamil Dibu, Eija Junttila, Teemu Luoto, Simona Šteblaj, Jacques Creteur, Dominique Durand, Caroline Abbenhuijs, Nancy Itesa Matumikina, Filippo Annoni, Leda Nobile, Miguel Ulloa Bersatti, Igor Yovenko, Alexander Tsarev, Jasperina Dubois, Evy Voets, Luc Janssen, Luigi Zattera, Leire Pedrosa, Berta Monleon Lopez, Ainhoa Serrano, Nekane Romero-García, Xavier Wittebole, Antonio Maria Dell'Anna, Camilla Gelormini, Eleonora Stival, Pilar Marcos Neira, Regina Roig Pineda, Lara Bielsa Berrocal, Maite Misis Del Campo, Jorge H Mejía-Mantilla, Ángela Marulanda, Wojciech Dabrowski, Rune Damgaard Nielsen, Markus Harboe Olsen, Helene Ravnholt Jensen, Ida Møller Larsen, Roberta Tallarico, Umberto Lucangelo, Maria Isabel Gonzalez Perez, Carole Ichai, Karim Asenhoune, Karim Lakhal, Charlotte Fernandez-Canal, Samuel Gay, Marie Lebouc, David Bougon, Etienne Escudier, Michel Sirodot, Albrice Levrat, Alix Courouau, Jacques Duranteau, Aurore Rodrigues, Naima Makouche, Gilles Francony, Olivier Vincent, Perrine Boucheix, Clotilde Schilte, Marie Cecile Fevre, Thomas Mistral, Marion Richard, Samia Salah, Pierluigi Banco, Angelina Pollet, Anais Adolle, Thomas Gargadennec, Patricia Dias, Gwenaelle Desanglois, Alexia Meheut, Pauline Cam, Liese Mebis, Alexandra Hendrickx, Pieter Wouters, Sylvia Van Hulle, Alain D'Hondt, Marjorie Beumier, Marc Burgeois, Olivier Simonet, Frederic Vallot, Pablo Centeno, Matias Anchorena, Ximena Benavente, Nydia Funes, Antonio Barra de Oca, Gabriela Izzo, Charlotte Castelain, Filip Soetens, Mario Arias, Diego Morocho, Manuel Jabaja, Diego Tutillo, Elena Perez Solada, Pilar Justo, Amparo Lopez Gomez, Sara Alcantara, Francisco Chico, Maria Fernanda Garcia, Fabricio Picoita, Stela Velasco Eichler, Gabriela Nonticuri Bianchi, João Pedro Britz, Jaqueline Almeida Pimentel, Mário Sérgio Fernandes, Hedi Gharsallah, Zied Hajjej, Walid Samoud, Oleg Grebenchikov, Valery Likhvantsev, Elena Stroiteleva, Nikolaos Markou, Dimitra Bakali, Dionysia Koutrafouri, Sara Maccherani, Janneke Horn, Arezoo Ahmadi, Lien Decaesteker, Daphne Decruyenaere, Ruth Demeersseman, Yves Devriendt, Karen Embo, Ditty van Duijn, Patricia Ormskerk, Melanie Glasbergen-van Beijeren, Raphael Cinotti, Cassia Righy, Serena Silva, Catherine Vandewaeter, Daniel Lemke, Ata Mahmoodpoor, Aaron Blandino-Ortiz, Mathieu Van der Jagt, Walter Videtta.
**Affiliations:**
1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
2. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium. (Contact: elisa.gouvea.bogossian@ulb.be)
3. Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil.
4. Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
5. Department of Neuroanaesthesiology, Rigshospitalet – University of Copenhagen, Copenhagen, Denmark.
6. Department of Clinical Medicine-Anesthesiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
7. Department of Intensive Care, AZ Delta, Roeselaere, Belgium.
8. Department of Intensive Care Medicine, Hospital Universitario de La Paz, Madrid, Spain.
9. Institute of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
10. Department of Anesthesiology and Intensive Care, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
11. Department of Intensive Care Medicine, DOr Institute of Research and Education, Rio de Janeiro, Brazil.
12. Department of Neurointensive Care, Instituto Estadual do Cerebro Paulo Niemeyer, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
13. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
14. Division of Intensive Care Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospital, Geneva, Switzerland.
15. Neurocritical Care Unit, Medical University Center (CUME), Porto, Portugal.
16. Anestesia and Intensive Care, Azienda Ospedaliera di Perugia, Perugia, Italy.
17. Department of Anesthesia and Intensive Care Medicine, AZ Groeninge, Kortrijk, Belgium.
18. Neurocritical Care Unit, Neurosurgical and Neurointerventional Anesthesiology Clinic, Division of Anesthesiology, Critical Care and Peri-Operative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
19. Department of Intensive Care Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
20. Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland.
21. Hamad Medical Corporation / Weill Cornell Medicine – Qatar, Doha, Qatar.
22. Tanta University Hospital, Tanta, El Gharbeya, Egypt.
23. Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Epagny Metz-Tessy, France.
24. Artemidis Zatti Hospital, Viedma, Rio Negro, Argentina.
25. Department of Intensive Care, Sklifosovsky Research Institute of Emergency Medicine of the Moscow Healthcare Department, Moscow, Russia.
26. Department of Intensive Care, State Research Center, Burnasyan Federal Medical Biophysical Center of Federal Medical Biological Agency, Moscow, Russia.
27. General Hospital of Eleusis Thriasion, Magoula, Greece.
28. Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.
**Identifiers:**
PMID: 39920710
PMCID: PMC11803982
DOI: 10.1186/s13054-025-05270-5
**Abstract:**
**Background:** The optimal hemoglobin (Hb) threshold for red blood cell transfusions (RBCT) in subarachnoid hemorrhage (SAH) patients remains uncertain. This study aimed to assess the impact of liberal versus restrictive transfusion strategies on neurological outcomes in SAH patients.
**Methods:** This research is a pre-planned secondary analysis of the "TRansfusion Strategies in Acute brain INjured Patients" (TRAIN) study. All SAH patients randomized to receive RBCT when Hb levels fell below 9 g/dL (liberal group) or 7 g/dL (restrictive group) were included. The primary endpoint was an unfavorable neurological outcome at 180 days, measured by the Glasgow Outcome Scale Extended score of 1-5.
**Results:** Among 190 SAH patients, data for the primary outcome were available for 188 (98.9%), with 86 (45.3%) in the liberal group and 102 (53.6%) in the restrictive group. The liberal group had older patients but similar baseline characteristics overall. They received more RBCT and maintained higher Hb levels. At 180 days, 57 (66.3%) in the liberal group and 78 (76.4%) in the restrictive group experienced unfavorable outcomes (risk ratio, RR 0.87; 95% CI 0.71-1.04). The liberal group had a significantly lower risk of cerebral ischemia (RR 0.63; 95% CI 0.41-0.97). Multivariate analysis indicated that randomization to the liberal group correlated with a lower risk of unfavorable outcomes (RR 0.83, 95% CI 0.70-0.99).
**Conclusions:** A liberal transfusion strategy did not correlate with a reduced incidence of unfavorable outcomes after SAH compared to a restrictive strategy. However, multivariable analysis indicated that randomization to the liberal group was linked to a decreased risk of unfavorable outcomes, with a significantly lower occurrence of cerebral ischemia noted in the liberal transfusion strategy group.
**Trial registration:** ClinicalTrials.gov number NCT02968654, registered on November 16, 2016.
**Keywords:** Acute brain injury; Anemia; Blood; Stroke.
© 2025. The Author(s).
**Publication types:** Randomized Controlled Trial
**MeSH terms:** Adult, Aged, Blood Transfusion / methods, Blood Transfusion / statistics & numerical data, Blood Transfusion / trends, Erythrocyte Transfusion / methods, Erythrocyte Transfusion / standards, Erythrocyte Transfusion / statistics & numerical data, Erythrocyte Transfusion / trends, Female, Humans, Male, Middle Aged, Subarachnoid Hemorrhage* / complications, Subarachnoid Hemorrhage* / therapy, Treatment Outcome.
**Citation**
Crit Care. 2025 Feb 7;29(1):67.
doi: 10.1186/s13054-025-05270-5.
**Authors**
Chahnez Taleb1, Elisa Gouvea Bogossian2, Carla Bittencour Rynkowski3,4, Kirsten Møller5,6, Piet Lormans7, Manuel Quintana Diaz8, Anselmo Caricato9, Luigi Zattera10, Pedro Kurtz11,12, Geert Meyfroidt13, Herve Quintard14, Maria Celeste Dias15, Angelo Giacomucci16, Charlotte Castelain17, Russell Chabanne18, Pilar Marcos-Neira19, Stepani Bendel20, Ahmed Subhy Alsheikhly21, Mohamed Elbahnasawy22, Samuel Gay23, Maximilian D'Onofrio24, Konstantin A Popugaev25,26, Nikolaos Markou27, Pierre Bouzat28, Jean-Louis Vincent1, Fabio Silvio Taccone1; TRAIN Study Trial Group
**Collaborators**
TRAIN Study Trial Group includes: Marco Antonio Cardoso Ferreira, Rafael Badenes, Christian Baastrup Sondergaard, Kirsten Colpaert, Leticia Petterson, Claudia Díaz, and many more contributors from diverse institutions.
**Affiliations**
1. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
2. Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (elisa.gouvea.bogossian@ulb.be).
3. Intensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil.
4. Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
5. Department of Neuroanaesthesiology, Rigshospitalet – University of Copenhagen, Copenhagen, Denmark.
6. Department of Clinical Medicine-Anesthesiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
7. Department of Intensive Care, AZ Delta, Roeselaere, Belgium.
8. Department of Intensive Care Medicine, Hospital Universitario de La Paz, Madrid, Spain.
9. Institute of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy.
10. Department of Anesthesiology and Intensive Care, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
11. Department of Intensive Care Medicine, DOr Institute of Research and Education, Rio de Janeiro, Brazil.
12. Department of Neurointensive Care, Instituto Estadual do Cerebro Paulo Niemeyer, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
13. Department and Laboratory of Intensive Care Medicine, University Hospitals Leuven and KU Leuven, Leuven, Belgium.
14. Division of Intensive Care Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospital, Geneva, Switzerland.
15. Neurocritical Care Unit, Medical University Center (CUME), Porto, Portugal.
16. Anestesia and Intensive Care, Azienda Ospedaliera di Perugia, Perugia, Italy.
17. Department of Anesthesia and Intensive Care Medicine, AZ Groeninge, Kortrijk, Belgium.
18. Neurocritical Care Unit, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
19. Department of Intensive Care Medicine, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.
20. Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland.
21. Hamad Medical Corporation / Weill Cornell Medicine – Qatar, Doha, Qatar.
22. Tanta University Hospital, Tanta, El Gharbeya, Egypt.
23. Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Epagny Metz-Tessy, France.
24. Artemidis Zatti Hospital, Viedma, Rio Negro, Argentina.
25. Department of Intensive Care, Sklifosovsky Research Institute of Emergency Medicine, Moscow, Russia.
26. Department of Intensive Care, Burnasyan Federal Medical Biophysical Center, Moscow, Russia.
27. General Hospital of Eleusis Thriasion, Magoula, Greece.
28. Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.
**PMID**: 39920710
**PMCID**: PMC11803982
**DOI**: 10.1186/s13054-025-05270-5
**Abstract**
**Background**: The appropriate hemoglobin (Hb) threshold for red blood cell transfusions (RBCT) in patients with subarachnoid hemorrhage (SAH) remains uncertain. This study investigates the effects of liberal versus restrictive transfusion strategies on neurological outcomes in SAH patients.
**Methods**: This analysis was part of the pre-planned secondary evaluation of the "TRansfusion Strategies in Acute brain INjured Patients" (TRAIN) study. It included SAH patients from the original trial, who were randomized to receive RBCT at Hb levels below 9 g/dL (liberal group) or 7 g/dL (restrictive group). The primary endpoint was unfavorable neurological outcome at 180 days, measured using the Glasgow Outcome Scale Extended score of 1-5.
**Results**: Among 190 SAH patients, 188 (98.9%) had data for the primary outcome, with 86 (45.3%) in the liberal group and 102 (53.6%) in the restrictive group. The liberal group had older patients but similar baseline characteristics. This group received more RBCT and had higher Hb levels over time. At 180 days, 57 (66.3%) in the liberal group and 78 (76.4%) in the restrictive group experienced unfavorable outcomes (risk ratio, RR 0.87; 95% CI 0.71-1.04). Notably, the liberal group exhibited a significantly lower risk of cerebral ischemia (RR 0.63; 95% CI 0.41-0.97). In multivariate analyses, the liberal transfusion strategy was linked to a reduced risk of unfavorable outcomes (RR 0.83, 95% CI 0.70-0.99).
**Conclusions**: The liberal transfusion approach did not demonstrate a lower incidence of unfavorable outcomes post-SAH compared to the restrictive strategy. However, in multivariable analysis, the liberal group showed a reduced risk of unfavorable outcomes, alongside significantly lower occurrences of cerebral ischemia.
**Trial registration**: ClinicalTrials.gov number-NCT02968654, registered on November 16, 2016.
**Keywords**: Acute brain injury; Anemia; Blood; Stroke.
© 2025. The Author(s).
**Publication types**
– Randomized Controlled Trial
**MeSH terms**
– Adult
– Aged
– Blood Transfusion / methods
– Blood Transfusion / statistics & numerical data
– Blood Transfusion / trends
– Erythrocyte Transfusion / methods
– Erythrocyte Transfusion / standards
– Erythrocyte Transfusion / statistics & numerical data
– Erythrocyte Transfusion / trends
– Female
– Humans
– Male
– Middle Aged
– Subarachnoid Hemorrhage* / complications
– Subarachnoid Hemorrhage* / therapy
– Treatment Outcome