Intensivmedizin Fragen und Antworten

13 · Klinische Studien
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when the hemoglobin concentration fell below 10.0 g per deciliter and hemoglobin
concentrations were maintained at 10.0 to 12.0 g per deciliter.
Results Overall, 30-day mortality was similar in the two groups (18.7 percent
vs. 23.3 percent, p=0.11). However, the rates were significantly lower with the
restrictive transfusion strategy among patients who were less acutely ill – those
with an Acute Physiology and Chronic Health Evaluation II score of ≤20 (8.7
percent in the restrictive-strategy group and 16.1 percent in the liberal-strategy
group; p=0.03) – and among patients who were less than 55 years of age (5.7
percent and 13.0 percent, respectively; p=0.02), but not among patients with
clinically significant cardiac disease (20.5 percent and 22.9 percent, respectively;
p=0.69). The mortality rate during hospitalization was significantly
lower in the restrictive strategy group (22.3 percent vs. 28.1 percent, p=0.05).
Conclusions A restrictive strategy of red-cell transfusion is at least as effective
as and possibly superior to a liberal transfusion strategy in critically ill patients,
with the possible exception of patients with acute myocardial infarction and
unstable angina.
Fazit
Eine restriktive Transfusionsstrategie bei Intensivpatienten war mindestens ebenso
effektiv, wenn nicht besser im Vergleich zu einer großzügigen Verfahrensweise.
Mögliche Ausnahmen hiervon waren Patienten mit akutem Myokardinfarkt und
instabiler Angina pectoris.
jBluttransfusion bei älteren Patienten mit akutem Myokardinfarkt
(n=78 974 Patienten, retrospektive Studie)
Wu WC, Rathore SS, Wang Y, Radford MJ, Krumholz HM (2001) Blood transfusion in elderly
patients with acute myocardial infarction. N Engl J Med 345: 1230–1236
Background Anemia may have adverse effects in patients with coronary artery
disease. However, the benefit of blood transfusion in elderly patients with
acute myocardial infarction and various degrees of anemia is uncertain.
Methods We conducted a retrospective study of data on 78 974 Medicare beneficiaries
65 years old or older who were hospitalized with acute myocardial
infarction. Patients were categorized according to the hematocrit on admission
(5.0 to 24.0 percent, 24.1 to 27.0 percent, 27.1 to 30.0 percent, 30.1 to 33.0 percent,
33.1 to 36.0 percent, 36.1 to 39.0 percent, or 39.1 to 48.0 percent), and data
were evaluated to determine whether there was an association between the use
of transfusion and 30-day mortality.