{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T17:22:34Z","timestamp":1758043354565,"version":"3.44.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">The effect of different thresholds for packed red blood cell transfusion on neurologic outcomes in patients with subarachnoid hemorrhage and anemia is uncertain. This meta\u2010analysis aimed to evaluate the effect of liberal versus restrictive transfusion strategies on functional outcomes in subarachnoid hemorrhage.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">We systematically searched MEDLINE (inception\u2013March 26, 2025) for randomized controlled trials comparing functional neurological outcomes in adults with aneurysmal subarachnoid hemorrhage assigned to receive packed red blood cell transfusion using high versus low hemoglobin thresholds. Risk of bias was assessed using Cochrane Risk of Bias tool 2.0. Unfavorable neurologic outcomes were defined based on trial\u2010specific primary neurologic outcome definitions (Glasgow Outcome Scale Extended score \u22645 or modified Rankin Scale score \u22653 or modified Rankin Scale score \u22654). An exploratory analysis using Glasgow Outcome Scale Extended score \u22645 or modified Rankin Scale score \u22653 as unfavorable neurologic outcome was also performed. We calculated the pooled risk ratio (RR) with 95% CI for unfavorable neurologic outcome using random effect models and assessed heterogeneity using Cochran's Q test.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              Of 1628 studies, 3 trials (n = 953 patients) met the inclusion criteria. Over a follow\u2010up of 3\u201312 months, 181\/470 patients (38.5%) randomized to liberal transfusion strategies (hemoglobin&lt;9\u201311.5g\/dL) compared with 214\/483 patients (44.3%) in the restrictive strategy group (hemoglobin&lt;7\u201310g\/dL) experienced unfavorable neurologic outcomes. Liberal (versus restrictive) packed red blood cell transfusion strategies resulted in a nonsignificant reduction (RR, 0.88; 95% CI, 0.77\u20131.01;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              = 0.06; I\n              <jats:sup>2<\/jats:sup>\n              = 0%) in unfavorable neurologic outcomes per trial\u2010specific definitions and RR = 0.89 (95% CI, 0.79\u20100.99;\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              = 0.04; I\n              <jats:sup>2<\/jats:sup>\n              = 0%) when unfavorable outcome was defined as Glasgow Outcome Scale Extended score \u22645 or modified Rankin Scale score \u22653. Sensitivity analysis, excluding the small pilot trial (n = 44) with a higher hemoglobin threshold, did not change the summary effect.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Our study demonstrated a trend toward better neurologic outcomes with liberal transfusion strategies in patients with subarachnoid hemorrhage. Further studies are required to determine the optimal transfusion strategy for this high\u2010risk population and identify subgroups that are most likely to benefit from the liberal strategy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/svin.125.001915","type":"journal-article","created":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T08:58:15Z","timestamp":1755507495000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Liberal Versus Restrictive Transfusion Strategy in Patients With Subarachnoid Hemorrhage: A Meta\u2010Analysis"],"prefix":"10.1161","volume":"5","author":[{"given":"Pargol","family":"Balali","sequence":"first","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lamya","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monisha A.","family":"Kumar","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett","family":"Cucchiara","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven","family":"Messe","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0418-6917","authenticated-orcid":false,"given":"Scott E.","family":"Kasner","sequence":"additional","affiliation":[{"name":"University of Pennsylvania","place":["Philadelphia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000284516.17580.2C"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31817c1095"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/strokeaha.109.556159"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3182054d06"},{"key":"e_1_3_2_6_2","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1001\/jama.2024.20424","article-title":"Restrictive vs liberal transfusion strategy in patients with acute brain injury: The TRAIN randomized clinical trial","volume":"332","author":"Taccone FS","year":"2024","unstructured":"Taccone FS, Rynkowski Bittencourt C, Moller K, Lormans P, Quintana\u2010Diaz M, Caricato A, Cardoso Ferreira MA, Badenes R, Kurtz P, Sondergaard CB, et\u00a0al. 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