6/30/23, 2:23 AM Transfusion strategies for acute upper GI bleeding Pathway Feedback Search Clinical Topics Home Studies Transfusion strategies for acute upper GI bleeding Transfusion strategies for acute upper GI bleeding Disease Non-variceal upper gastrointesti Trial question What is the role of restrictive transfusion strategy in patients with severe acute upper gastrointestinal bleeding? Study design Single center Open label RCT Population Characteristics of study participants 32.0% female N = 921 68.0% male 921 patients (284 female, 605 male) Inclusion criteria: patients with severe acute upper gastrointestinal bleeding Key exclusion criteria: massive exsanguinating bleeding; an acute coronary syndrome, symptomatic peripheral vasculopathy, stroke, TIA, or transfusion within the previous 90 days; a recent history of trauma or surgery; or lower gastrointestinal bleeding Interventions N=461 restrictive blood transfusion therapy (transfusion when the Hgb level fell below 7 g/dL) N=460 liberal blood transfusion therapy (transfusion when the Hgb fell < 9 g/dL) Primary outcome https://web.pathway.md/studies/recCLx4ijXGIpAdIn 1/2 6/30/23, 2:23 AM Transfusion strategies for acute upper GI bleeding Pathway Death at 45 days 9.0 % 9 6.8 % 5 4.5 % Significant decrease 2.3 % NNT = 25 0.0 % Restrictive blood transfusion therapy Liberal blood transfusion therapy Significant decrease in death at 45 days (5% vs. 9%; HR 0.55, 95% CI 0.33 to 0.92) Secondary outcomes Significant decrease in further bleeding (10% vs. 16%; HR 0.62, 95% CI 0.43 to 0.91) No significant difference in death, in patients with bleeding from peptic ulcer (3% vs. 5%; HR 0.7, 95% CI -0.51 to 1.91) Significant decrease in death, in patients with cirrhosis and Child-Pugh class A or B (4% vs. 12%; HR 0.3, 95% CI 0.11 to 0.85) Safety outcomes Significant differences in adverse events (40% vs. 48%, p = 0.02). Conclusion In patients with severe acute upper gastrointestinal bleeding, restrictive blood transfusion therapy was superior to liberal blood transfusion therapy with respect to death at 45 days. Reference Villanueva C, Colomo A, Bosch A et al. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3;368(1):11-21. Open reference URL https://web.pathway.md/studies/recCLx4ijXGIpAdIn 2/2