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Blood Transfusion in Patients With Acute Coronary Syndrome—Reply
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In Reply: Mr Rathore and Drs Radford and Krumholz express concern about our conclusions, which differ from those of their study.1 While both studies find that transfusion for a hematocrit value of 36% or more is associated with increased mortality, their study suggests that transfusion for a hematocrit below 30% is associated with decreased mortality. We could not identify a hematocrit threshold below which transfusion was beneficial, but we found that transfusion for a hematocrit greater than 25% was associated with harm. Therefore, the issue is not whether blood transfusion is harmful but the inflection point at which it is associated with harm. Of the 2 studies they cite in support of liberal transfusion, one is an observational study that found a benefit of transfusion only in an unadjusted analysis of 202 patients with a "cardiovascular diagnosis" and an Acute Physiology and Chronic Health Evaluation score of more than 20,2 . . . [Full Text of this Article]
Sunil V. Rao, MD
sunil.rao@duke.edu
Robert A. Harrington, MD;
Robert M. Califf, MD
Duke Clinical Research Institute
Durham, NC
Jonathan S. Stamler, MD
Howard Hughes Medical Institute
Duke University Medical Center
Durham, NC
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