Comparative efficacy of liberal and restrictive blood transfusion strategies in anemic patients with acute myocardial infarction: A systematic review and meta-analysis of randomized controlled trials

Introduction: Acute myocardial infarction (AMI) poses a significant global health burden, warranting meticulous management strategies, particularly in patients with concurrent anemia. Blood transfusion strategies play a pivotal role in optimizing oxygen delivery while minimizing transfusion-related risks. Two contrasting approaches, liberal and restrictive transfusion strategies, have emerged, yet their comparative effectiveness remains uncertain due to conflicting evidence. 

Methods: We conducted a systematic review and meta-analysis focusing on randomized controlled trials (RCTs) comparing liberal versus restrictive transfusion strategies in AMI patients with anemia (hemoglobin levels <10 g/dL). Comprehensive searches were performed across electronic databases up to March 31, 2024. Data extraction, risk of bias assessment using Cochrane's RoB 2 tool, and meta-analysis were conducted following methodology. 

Results: Among 327 initially identified studies, four high-quality RCTs met the inclusion criteria. These trials encompassed varied sample sizes and patient demographics. Meta-analysis revealed no significant difference in 30-day all-cause mortality nor recurrent MI between liberal and restrictive transfusion strategies. However, combining these outcomes into a composite measure demonstrated a significant reduction favoring liberal transfusion (pooled odds ratio = 0.82; 95% confidence interval = 0.69–0.99). 

Conclusion: While liberal transfusion strategies show promise in reducing adverse outcomes, clinical decision-making should be guided by individual patient factors and preferences. Personalized care remains paramount in determining the most appropriate transfusion approach for AMI patients with anemia. Further research is warranted to elucidate the optimal transfusion strategy in this population.