SynthesisNeurocritical care2026
Restrictive vs. Liberal Transfusion Strategy in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-analysis.
Synthesis in Neurocritical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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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.
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Authors and funding
6 authors.
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Abstract
The indications of red blood cell transfusions in the absence of life-threatening bleeding in neurocritical individuals are controversial. Recently, three large randomized controlled trials assessed transfusion strategies in this population, allowing an update of a previous meta-analysis, including a sample seven times bigger than the one analyzed previously. We performed a systematic review and updated meta-analysis of liberal versus restrictive transfusion strategy in patients with acute brain injury, comprising traumatic brain injury (TBI), intracerebral hemorrhage, and subarachnoid hemorrhage. A review protocol was registered on PROSPERO (CRD42024616143). We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials comparing liberal versus restrictive transfusion strategy in neurocritical patients. We used Review Manager 5.4 to apply a random-effects model to pool risk ratios (RRs) and 95% confidence intervals (CIs), as available in the individual studies. Quality assessment was performed through the Cochrane Risk of Bias assessment tool (RoB 2.0 tool). Six randomized clinical trials were included, comprising 2,497 patients, of whom 1,431 presented with TBI. The liberal transfusion strategy led to statistically significant lower rates of unfavorable neurological outcomes compared to the restrictive strategy (RR 0.89; 95% CI 0.83-0.96; p = 0.002; I
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