NoBlood

Jan B. Wade · #1 (**permalink**) 10-05-2004, 02:39 PM

http://www.reuters.co.uk/newsArticle...6&section=news

Transfusing Heart Patients Poses Risk -Study
Tue October 05, 2004 04:04 PM ET

CHICAGO (Reuters) - Giving blood transfusions to patients with acute heart problems nearly triples the risk they will die or suffer a heart attack within a month, a study said on Tuesday.

The reason is not entirely clear, but researchers believe the blood used in the increasingly common procedure is often depleted of substances such as nitrous oxide that help deliver oxygen to the body's tissues.

Transfused blood also may increase inflammation and further constrict blocked arteries and make the heart pump harder.

Overall, the analysis of three studies with more than 24,000 participants found 29 percent of the heart patients who got a transfusion died or had another heart attack within 30 days, compared to 10 percent of heart patients who did not get a transfusion.

The risk of dying was 8 percent among transfused patients, versus 3 percent for those who were not.

Transfusions are given to patients who have anemia because of bleeding or a deficiency of oxygen-carrying red blood cells.

In the United States, some 12 million units of blood are transfused into 3.5 million patients annually. The procedure has become more common among heart patients with the introduction of blood thinners to deter clots and more invasive procedures to unclog arteries.

The report does not call for an end to transfusions for heart patients. Instead, study author Dr. Sunil Rao of the Duke Clinical Research Institute in Durham, North Carolina, urged greater caution when deciding whether to transfuse anemic patients and suggested another study to determine the best approach.

"Blood transfusion may, at best, be neutral with respect to survival or, at worst, be associated with either decreased survival or worsening cardiac function," based on previous studies, said the report published in this week's Journal of the American Medical Association. "(Our study) should not be considered as evidence to change practice; rather, it should be considered as evidence that caution is warranted when making transfusion decisions."

Jan B. Wade · #2 (**permalink**) 10-14-2004, 04:01 AM

http://www.onlypunjab.com/real/fulls...wsID-4875.html

Heart attack patients who receive blood transfusions have higher death rate
Publish Date : 10/13/2004 7:45:00 AM Source : Onlypunjab.com Correspondent

Receiving a blood transfusion is associated with a greater risk of death for patients with acute coronary syndromes, such as a myocardial infarction (heart attack), according to a study in the October 6 issue of JAMA.

The use of invasive procedures for treatment of ischemic heart disease has more than tripled in the past 2 decades and is likely to increase in high-risk patients, according to background information in the article. This, coupled with the widespread use of antithrombotic drugs, has increased the potential for bleeding and blood transfusion among patients with cardiovascular disease. Approximately 12 million units of blood are transfused to 3.5 million patients each year in the United States, and although transfusing blood to anemic patients with ischemic heart disease may theoretically increase oxygen delivery and improve outcomes, there is no definitive evidence to support such a practice, according to the article.

Patients hospitalized for an acute coronary syndrome (ACS) are at risk of developing anemia acutely as a consequence of bleeding. For clinical practice, a crucial issue is whether blood transfusion is beneficial or harmful for patients with ischemic heart disease who have developed anemia acutely during their hospitalization. Clinical studies have had differing results.

Sunil V. Rao, M.D., of the Duke Clinical Research Institute, Durham, N.C., and colleagues used clinical data from three large international trials of patients with ACS to determine the association between blood transfusion and outcomes among patients who developed moderate to severe bleeding, anemia, or both during their hospitalization. The study included 24,111 participants in the GUSTO IIb, PURSUIT, and PARAGON B trials. Patients were grouped according to whether they received a blood transfusion during hospitalization.

Of the patients included, 2,401 (10.0 percent) underwent at least 1 blood transfusion during their hospitalization. The researchers found that the rates for three outcomes (30-day death, heart attack, and composite death/heart attack) were significantly higher among patients who received a transfusion (30-day death, 8.00 percent for patients who received a transfusion vs. 3.08 percent for patients who did not; 30-day heart attack, 25.16 percent vs. 8.16 percent; 30-day composite death/heart attack, 29.24 percent vs. 10.02 percent). Blood transfusion was associated with a nearly four times increased risk for 30-day death and nearly three times increased risk for 30-day death/heart attack. In further analysis that included procedures and bleeding events, transfusion was associated with a trend toward increased risk of death.

"Given the disparity in results between our study and other observational studies of transfusion and outcome, a randomized trial of transfusion strategies in anemic patients with ACS is warranted to guide clinical practice. Until then, we caution against the routine use of blood transfusions to maintain arbitrary [certain blood measurement] levels in stable patients with ischemic heart disease," the authors write.