Trial reportAmerican heart journal2013
Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease.
Trial report in American heart journal, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 116 papers, 21 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Myocardial Ischemia and Transfusion Pilot
Cost-effectiveness and Cost-utility of Liberal vs Restrictive Red Blood Cell Transfusion Strategies in Patients With Acute Myocardial Infarction and Anaemia. The REALITY (REstrictive And LIberal Transfusion Strategies in Patients With Acute mYocardial Infarction) Randomized Trial.
Myocardial Ischemia and Transfusion
Who cites it
116 citing papers in PubMed, 21 syntheses or guidelines pooled it.
- Transfusion thresholds and other strategies for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2025Pooled it
- Restrictive versus Liberal Transfusion in Myocardial Infarction - A Patient-Level Meta-Analysis.NEJM evidence · 2025Pooled it
- Guideline
- Liberal versus restrictive red blood cell transfusion strategy in acute coronary syndrome and anemia: an updated systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2025Pooled it
- Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.The Cochrane database of systematic reviews · 2024Pooled it
- Restrictive versus Liberal Transfusion Strategies in Acute Myocardial Infarction and Anemia: A Meta-Analysis and Trial Sequential Analysis.Arquivos brasileiros de cardiologia · 2024Pooled it
- Transfusion Thresholds for Acute Coronary Syndromes-Insights From the TRICS-III Randomized Controlled Trial, Systematic Review, and Meta-Analysis.Journal of the American Heart Association · 2023Pooled it
- Transfusion thresholds for guiding red blood cell transfusion.The Cochrane database of systematic reviews · 2021Pooled it
- Meta-analysis of restrictive versus liberal blood transfusion among patients with coronary artery disease.Journal of thrombosis and thrombolysis · 2021Pooled it
- Restrictive vs. Liberal Red Blood Cell Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: A Systematic Review and Meta-Analysis.Frontiers in cardiovascular medicine · 2021Pooled it
- Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine.Intensive care medicine · 2020Guideline
- Pooled it
- Risks of restrictive red blood cell transfusion strategies in patients with cardiovascular disease (CVD): a meta-analysis.Transfusion medicine (Oxford, England) · 2018Pooled it
- Should Transfusion Trigger Thresholds Differ for Critical Care Versus Perioperative Patients? A Meta-Analysis of Randomized Trials.Critical care medicine · 2018Pooled it
- Restrictive versus liberal red blood cell transfusion strategies for people with haematological malignancies treated with intensive chemotherapy or radiotherapy, or both, with or without haematopoietic stem cell support.The Cochrane database of systematic reviews · 2017Pooled it
- Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion.The Cochrane database of systematic reviews · 2016Pooled it
- Prolonged High-Dose Bivalirudin Infusion Reduces Major Bleeding Without Increasing Stent Thrombosis in Patients Undergoing Primary Percutaneous Coronary Intervention: Novel Insights From an Updated Meta-Analysis.Journal of the American Heart Association · 2016Pooled it
- Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis.BMJ (Clinical research ed.) · 2016Pooled it
- Red blood cell transfusion for people undergoing hip fracture surgery.The Cochrane database of systematic reviews · 2015Pooled it
- Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis.BMJ (Clinical research ed.) · 2015Pooled it
56 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
17 authors.
Funding
Abstract
backgroundPrior trials suggest it is safe to defer transfusion at hemoglobin levels above 7 to 8 g/dL in most patients. Patients with acute coronary syndrome may benefit from higher hemoglobin levels.
methodsWe performed a pilot trial in 110 patients with acute coronary syndrome or stable angina undergoing cardiac catheterization and a hemoglobin <10 g/dL. Patients in the liberal transfusion strategy received one or more units of blood to raise the hemoglobin level ≥10 g/dL. Patients in the restrictive transfusion strategy were permitted to receive blood for symptoms from anemia or for a hemoglobin <8 g/dL. The predefined primary outcome was the composite of death, myocardial infarction, or unscheduled revascularization 30 days post randomization.
resultsBaseline characteristics were similar between groups except age (liberal, 67.3; restrictive, 74.3). The mean number of units transfused was 1.6 in the liberal group and 0.6 in the restrictive group. The primary outcome occurred in 6 patients (10.9%) in the liberal group and 14 (25.5%) in the restrictive group (risk difference = 15.0%; 95% confidence interval of difference 0.7% to 29.3%; P = .054 and adjusted for age P = .076). Death at 30 days was less frequent in liberal group (n = 1, 1.8%) compared to restrictive group (n = 7, 13.0%; P = .032).
conclusionsThe liberal transfusion strategy was associated with a trend for fewer major cardiac events and deaths than a more restrictive strategy. These results support the feasibility of and the need for a definitive trial.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.