A Rutgers Health-led study published in NEJM Evidence indicates that a more liberal approach to blood transfusions in anemic patients following a heart attack may lead to improved survival rates. The research, a meta-analysis of four clinical trials involving 4,311 patients, suggests that increasing blood transfusions in this population could reduce the risk of death at six months.
The study, spearheaded by Jeffrey L. Carson, provost and Distinguished Professor of medicine at Rutgers Robert Wood Johnson Medical School, builds upon earlier research from 2023 known as the MINT (myocardium infarction and transfusion) trial. This previous trial suggested a higher mortality rate and increased recurrent heart attacks in anemic patients receiving fewer blood transfusions.
Study Details and Findings
The meta-analysis combined data from clinical trials conducted in France and the United States, all focusing on blood transfusion strategies in patients who had experienced a heart attack and presented with low blood counts indicative of anemia. The trials compared outcomes between patients receiving fewer transfusions versus those receiving more.
While the analysis did not definitively establish a causal link between fewer transfusions and increased risk of death or heart attack at 30 days, it did reveal a trend suggesting that a restrictive transfusion strategy was associated with a higher risk of death at six months. Specifically, the original clinical trial data showed that the frequency of mortality or recurrent heart attack was 2.4% lower when a more liberal transfusion approach was employed, although this finding was not statistically significant.
Patient Population and Implications
The study population consisted largely of individuals with pre-existing conditions such as prior heart attacks, heart failure, diabetes, or kidney disease. The average age of participants was 72, with women comprising 45% of the cohort. These factors highlight the complexity of managing anemia in the context of acute myocardial infarction and co-existing comorbidities.
"The results of this analysis show that giving more blood to anemic patients with heart attacks can save lives at six months," said Carson. He has dedicated nearly two decades to studying red blood cell transfusion strategies, contributing to the establishment of transfusion guidelines in 2012, which were recently updated in the Journal of the American Medical Association to emphasize individualized patient care.
Funding and Future Directions
Both the current study and the preceding MINT trial were funded by the National Heart, Lung and Blood Institute, a component of the National Institutes of Health. These findings underscore the need for continued research to refine transfusion strategies and optimize outcomes for anemic patients post-heart attack.
