Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis
BackgroundInternational guidelines acknowledge the lack of subarachnoid hemorrhage (SAH) specific red blood cell transfusion thresholds. This study aimed to evaluate the efficacy and safety of red blood cell transfusion strategies in patients with SAH.MethodsWe systematically searched PubMed/MEDLINE...
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| Formato: | Artículo de revisión |
| Lenguaje: | inglés |
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2026
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| author | Johann Bill Pinedo‐Avila Grover Rodas-Utani Victor Antonio Ramirez Palomino Vanessa Sonia Joanna Saavedra Niño Samuel Chambilla Mamani David R. Soriano‐Moreno |
| author_browse | David R. Soriano‐Moreno Grover Rodas-Utani Johann Bill Pinedo‐Avila Samuel Chambilla Mamani Vanessa Sonia Joanna Saavedra Niño Victor Antonio Ramirez Palomino |
| author_facet | Johann Bill Pinedo‐Avila Grover Rodas-Utani Victor Antonio Ramirez Palomino Vanessa Sonia Joanna Saavedra Niño Samuel Chambilla Mamani David R. Soriano‐Moreno |
| author_sort | Johann Bill Pinedo‐Avila |
| collection | Producción científica |
| description | BackgroundInternational guidelines acknowledge the lack of subarachnoid hemorrhage (SAH) specific red blood cell transfusion thresholds. This study aimed to evaluate the efficacy and safety of red blood cell transfusion strategies in patients with SAH.MethodsWe systematically searched PubMed/MEDLINE, CENTRAL, EMBASE, and Google Scholar from inception to July 15, 2025. We included randomized controlled trials (RCTs) evaluating any transfusion strategy in SAH patients. Meta-analyses were conducted using random-effects models, and the certainty of evidence was assessed using the GRADE minimally contextualized approach. The protocol was registered in PROSPERO (CRD420251122925).ResultsThree RCTs comprising 966 participants were included. Two compared restrictive (hemoglobin threshold 7-8 g/dL) versus liberal (9-10 g/dL) transfusion strategies, and one compared a higher (≥11.5 g/dL) versus lower (≥10 g/dL) hemoglobin targets. A liberal transfusion strategy, compared with the restrictive approach, probably reduces unfavorable neurological outcomes (39.6% vs 45.5%; risk difference [RD]: -5 per 100; 95% CI: -10 to +1) and new cerebral ischemia (17.7% vs 22.9%; RD: -5 per 100; 95% CI: -11 to +2), while probably increasing hemoglobin levels (mean difference [MD]: +1.68 g/dL; 95% CI: +0.32 to +3.04), transfusion requirements (98.2% vs 37.7%; RD: +52 per 100; 95% CI: +24 to +92), and ICU length of stay (MD: +1.16 days; 95% CI: -0.11 to +2.42). It may also reduce the risk of cerebral vasospasm (30.0% vs 36.4%; RD: -5 per 100; 95% CI: -14 to +9), although the evidence is very uncertain. Evidence for higher versus lower hemoglobin targets (≥11.5 g/dL vs ≥10 g/dL) was very uncertain across all outcomes.ConclusionCompared with a restrictive strategy, a liberal transfusion approach in patients with SAH probably improves neurological outcomes and reduces cerebral ischemia. Evidence for higher hemoglobin targets remains very uncertain, underscoring the need for larger, high-quality trials to refine optimal transfusion thresholds. |
| format | Review |
| id | openalex:W7161810261 |
| institution | UPeU |
| language | English |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
| record_format | dspace |
| spelling | openalex:W7161810261Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-AnalysisJohann Bill Pinedo‐AvilaGrover Rodas-UtaniVictor Antonio Ramirez PalominoVanessa Sonia Joanna Saavedra NiñoSamuel Chambilla MamaniDavid R. Soriano‐Morenosubarachnoid hemorrhagered blood cell transfusionrestrictive transfusionliberal transfusionhemoglobin thresholdhemoglobin targetneurological outcomecerebral ischemiacerebral vasospasmICU length of staytransfusion requirementsanemia managementhemorrhagic strokestroke recurrencestroke mortalitystroke complicationsBlood transfusion and managementIntracranial Aneurysms: Treatment and ComplicationsTrauma, Hemostasis, Coagulopathy, ResuscitationBackgroundInternational guidelines acknowledge the lack of subarachnoid hemorrhage (SAH) specific red blood cell transfusion thresholds. This study aimed to evaluate the efficacy and safety of red blood cell transfusion strategies in patients with SAH.MethodsWe systematically searched PubMed/MEDLINE, CENTRAL, EMBASE, and Google Scholar from inception to July 15, 2025. We included randomized controlled trials (RCTs) evaluating any transfusion strategy in SAH patients. Meta-analyses were conducted using random-effects models, and the certainty of evidence was assessed using the GRADE minimally contextualized approach. The protocol was registered in PROSPERO (CRD420251122925).ResultsThree RCTs comprising 966 participants were included. Two compared restrictive (hemoglobin threshold 7-8 g/dL) versus liberal (9-10 g/dL) transfusion strategies, and one compared a higher (≥11.5 g/dL) versus lower (≥10 g/dL) hemoglobin targets. A liberal transfusion strategy, compared with the restrictive approach, probably reduces unfavorable neurological outcomes (39.6% vs 45.5%; risk difference [RD]: -5 per 100; 95% CI: -10 to +1) and new cerebral ischemia (17.7% vs 22.9%; RD: -5 per 100; 95% CI: -11 to +2), while probably increasing hemoglobin levels (mean difference [MD]: +1.68 g/dL; 95% CI: +0.32 to +3.04), transfusion requirements (98.2% vs 37.7%; RD: +52 per 100; 95% CI: +24 to +92), and ICU length of stay (MD: +1.16 days; 95% CI: -0.11 to +2.42). It may also reduce the risk of cerebral vasospasm (30.0% vs 36.4%; RD: -5 per 100; 95% CI: -14 to +9), although the evidence is very uncertain. Evidence for higher versus lower hemoglobin targets (≥11.5 g/dL vs ≥10 g/dL) was very uncertain across all outcomes.ConclusionCompared with a restrictive strategy, a liberal transfusion approach in patients with SAH probably improves neurological outcomes and reduces cerebral ischemia. Evidence for higher hemoglobin targets remains very uncertain, underscoring the need for larger, high-quality trials to refine optimal transfusion thresholds.Reviewhttps://doi.org/10.1177/08850666261452579W7161810261enJournal of Intensive Care Medicine0885-06661525-14892026-05-20 |
| spellingShingle | subarachnoid hemorrhage red blood cell transfusion restrictive transfusion liberal transfusion hemoglobin threshold hemoglobin target neurological outcome cerebral ischemia cerebral vasospasm ICU length of stay transfusion requirements anemia management hemorrhagic stroke stroke recurrence stroke mortality stroke complications Blood transfusion and management Intracranial Aneurysms: Treatment and Complications Trauma, Hemostasis, Coagulopathy, Resuscitation Johann Bill Pinedo‐Avila Grover Rodas-Utani Victor Antonio Ramirez Palomino Vanessa Sonia Joanna Saavedra Niño Samuel Chambilla Mamani David R. Soriano‐Moreno Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title | Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title_full | Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title_fullStr | Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title_short | Approaches to Guide Red Blood Cell Transfusion in Patients with Subarachnoid Hemorrhage: A Systematic Review and Meta-Analysis |
| title_sort | approaches to guide red blood cell transfusion in patients with subarachnoid hemorrhage a systematic review and meta analysis |
| topic | subarachnoid hemorrhage red blood cell transfusion restrictive transfusion liberal transfusion hemoglobin threshold hemoglobin target neurological outcome cerebral ischemia cerebral vasospasm ICU length of stay transfusion requirements anemia management hemorrhagic stroke stroke recurrence stroke mortality stroke complications Blood transfusion and management Intracranial Aneurysms: Treatment and Complications Trauma, Hemostasis, Coagulopathy, Resuscitation |
| topic_facet | subarachnoid hemorrhage red blood cell transfusion restrictive transfusion liberal transfusion hemoglobin threshold hemoglobin target neurological outcome cerebral ischemia cerebral vasospasm ICU length of stay transfusion requirements anemia management hemorrhagic stroke stroke recurrence stroke mortality stroke complications Blood transfusion and management Intracranial Aneurysms: Treatment and Complications Trauma, Hemostasis, Coagulopathy, Resuscitation |
| url | https://doi.org/10.1177/08850666261452579 |
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