{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T17:02:06Z","timestamp":1794330126840,"version":"4.9.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"19","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2024,11,19]]},"abstract":"\n Importance<\/jats:title>\n Blood transfusions are commonly administered to patients with acute brain injury. The optimal hemoglobin transfusion threshold is uncertain in this patient population.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the impact on neurological outcome of 2 different hemoglobin thresholds to guide red blood cell transfusions in patients with acute brain injury.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n Multicenter, phase 3, parallel-group, investigator-initiated, pragmatic, open-label randomized clinical trial conducted in 72 intensive care units across 22 countries. Eligible patients had traumatic brain injury, aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage; hemoglobin values below 9 g\/dL within the first 10 days after injury; and an expected intensive care unit stay of at least 72 hours. Enrollment occurred between September 1, 2017, and December 31, 2022. The last day of follow-up was June 30, 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Eight hundred fifty patients were randomly assigned to undergo a liberal (transfusion triggered by hemoglobin &amp;lt;9 g\/dL; n\u2009=\u2009408) or a restrictive (transfusion triggered by hemoglobin &amp;lt;7 g\/dL; n\u2009=\u2009442) transfusion strategy over a 28-day period.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was occurrence of an unfavorable neurological outcome, defined as a Glasgow Outcome Scale Extended score between 1 and 5, at 180 days following randomization. There were 14 prespecified serious adverse events, including occurrence of cerebral ischemia after randomization.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 820 patients who completed the trial (mean age, 51 years; 376 [45.9%] women), 806 had available data on the primary outcome, 393 in the liberal strategy group and 413 in the restrictive strategy group. The liberal strategy group received a median of 2 (IQR, 1-3) units of blood, and the restrictive strategy group received a median of 0 (IQR, 0-1) units of blood, with an absolute mean difference of 1.0 unit (95% CI, 0.87-1.12 units). At 180 days after randomization, 246 patients (62.6%) in the liberal strategy group had an unfavorable neurological outcome compared with 300 patients (72.6%) in the restrictive strategy group (absolute difference, \u221210.0% [95% CI, \u221216.5% to \u22123.6%]; adjusted relative risk, 0.86 [95% CI, 0.79-0.94];\n P<\/jats:italic>\n \u2009=\u2009.002). The effect of the transfusion thresholds on neurological outcome at 180 days was consistent across prespecified subgroups. In the liberal strategy group, 35 (8.8%) of 397 patients had at least 1 cerebral ischemic event compared with 57 (13.5%) of 423 in the restrictive strategy group (relative risk, 0.65 [95% CI, 0.44-0.97]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02968654<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2024.20424","type":"journal-article","created":{"date-parts":[[2024,10,9]],"date-time":"2024-10-09T08:30:55Z","timestamp":1728462655000},"page":"1623","source":"Crossref","is-referenced-by-count":182,"title":["Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury"],"prefix":"10.1001","volume":"332","author":[{"given":"Fabio Silvio","family":"Taccone","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Erasme Hospital, Universit\u00e9 Libre de Bruxelles, Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla Bittencourt","family":"Rynkowski","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Cristo Redentor Hospital, Porto Alegre, Brazil"},{"name":"Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"M\u00f8ller","sequence":"additional","affiliation":[{"name":"Department of Neuroanaesthesiology and Neurosurgery, Neuroscience Centre, Copenhagen University, Hospital Rigshospitalet, Copenhagen, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, 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