Opinion Editorials represent the opinions of the authors and JAMA EDITORIAL and not those of the American Medical Association. New Convincing Evidence Jeffrey L. Carson, MD In this issue of JAMA, Rohde and colleagues report results of a The only outcome evaluated in the report by Rohde et al meta-analysisevaluatingtheassociationbetweenaliberaltrans- was infection risk. However, other important outcomes such fusion strategy vs a restrictive strategy and risk of hospital- as mortality, myocardial infarction, and function should be con- acquired infections. In the sidered in the overall risk-benefit analysis of transfusion. A pre- meta-analysis,whichincluded viously published meta-analysis found a statistically nonsig- 17 randomized trials that com- nificant reduction in mortality associated with a restrictive Related article page 1317 pared these strategies among transfusion approach and a recent trial in patients with up- 7456patients,theabsoluteratesofserioushospital-associatedin- per gastrointestinal bleeding found a significantly lower risk fection were 12.7% in the liberal transfusion group and 10.6% in of death at 45 days follow-up in the restrictive transfusion group therestrictivetransfusiongroup.Thenumberneededtotreatwith compared with a liberal transfusion group. Also, liberal trans- arestrictivetransfusionstrategytopreventseriousinfectionwas fusion does not improve walking ability or other measures of about 48 patients. Results were consistent when analyses were daily functioning in hip fracture patients. repeated in
JAMA – American Medical Association
Published: Apr 2, 2014
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