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In this randomised trial using a factorial design (2 x 2) in 200 patients with traumatic brain injury, the authors assessed whether the use of a liberal transfusion strategy (haemoglobin threshold of 10 g/dL), compared with a restrictive strategy (haemoglobin threshold of 7 g/dL), and/or the administration of recombinant human erythropoietin, compared with placebo, would increase the rate of favourable outcomes (measured using the Glasgow Outcome Scale) at 6 months postinjury.

Neither a higher transfusion threshold nor the administration of recombinant human erythropoietin resulted in improved neurological outcome at 6 months. In addition, the liberal transfusion strategy was associated with a higher incidence of thromboembolic events (21.8 vs. 8.1%; P = 0.009). Due to its factorial design, the study lost in quality. Indeed, the number of patients was very low in some groups (20 patients), which limits the power of this study.

However, when all published trials comparing liberal and restrictive transfusion strategies are considered (e.g., in the settings of cardiac surgery, gastrointestinal bleeding or intensive care), there is little room for a liberal transfusion strategy in the intensive care unit.

– Michael Piagnerelli

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