Background
\nThe hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal
\nbleeding is controversial. We compared the efficacy and safety of a restrictive
\ntransfusion strategy with those of a liberal transfusion strategy.
\nMethods
\nWe enrolled 921 patients with severe acute upper gastrointestinal bleeding and randomly
\nassigned 461 of them to a restrictive strategy (transfusion when the hemoglobin
\nlevel fell below 7 g per deciliter) and 460 to a liberal strategy (transfusion
\nwhen the hemoglobin fell below 9 g per deciliter). Randomization was stratified
\naccording to the presence or absence of liver cirrhosis.
\nResults
\nA total of 225 patients assigned to the restrictive strategy (51%), as compared with
\n65 assigned to the liberal strategy (15%), did not receive transfusions (P<0.001). The\nprobability of survival at 6 weeks was higher in the restrictive-strategy group than\nin the liberal-strategy group (95% vs. 91%; hazard ratio for death with restrictive\nstrategy, 0.55; 95% confidence interval [CI], 0.33 to 0.92; P = 0.02). Further bleeding\noccurred in 10% of the patients in the restrictive-strategy group as compared with\n16% of the patients in the liberal-strategy group (P = 0.01), and adverse events occurred\nin 40% as compared with 48% (P = 0.02). The probability of survival was\nslightly higher with the restrictive strategy than with the liberal strategy in the\nsubgroup of patients who had bleeding associated with a peptic ulcer (hazard ratio,\n0.70; 95% CI, 0.26 to 1.25) and was significantly higher in the subgroup of patients\nwith cirrhosis and Child\u2013Pugh class A or B disease (hazard ratio, 0.30; 95% CI, 0.11 to\n0.85), but not in those with cirrhosis and Child\u2013Pugh class C disease (hazard ratio,\n1.04; 95% CI, 0.45 to 2.37). Within the first 5 days, the portal-pressure gradient\nincreased significantly in patients assigned to the liberal strategy (P = 0.03) but not\nin those assigned to the restrictive strategy.\nConclusions\nAs compared with a liberal transfusion strategy, a restrictive strategy significantly\nimproved outcomes in patients with acute upper gastrointestinal bleeding. (Funded\nby Fundaci\u00f3 Investigaci\u00f3 Sant Pau; ClinicalTrials.gov number, NCT00414713.)<\/div>\n","protected":false},"excerpt":{"rendered":"

Editorial: n engl j med Fecha: 01\/01\/2013 C\u00e0ndid Villanueva, M.D., Alan Colomo, M.D., Alba Bosch, M.D.,et al. Acceso al enlace<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4],"tags":[],"_links":{"self":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/431"}],"collection":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/comments?post=431"}],"version-history":[{"count":1,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/431\/revisions"}],"predecessor-version":[{"id":656,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/posts\/431\/revisions\/656"}],"wp:attachment":[{"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/media?parent=431"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/categories?post=431"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/awge.doctime.es\/index.php\/wp-json\/wp\/v2\/tags?post=431"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}