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Kiyohara Y, Briasoulis A, Kuno T. Comparison of blood transfusion strategies for acute coronary syndrome patients with anemia: A meta-analysis of five randomized controlled trials. J Cardiol 2024:S0914-5087(24)00068-6. [PMID: 38642888 DOI: 10.1016/j.jjcc.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 04/12/2024] [Accepted: 04/14/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Yuko Kiyohara
- Department of Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Section of Heart Failure and Transplantation, University of Iowa, Iowa City, IA, USA
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, Bronx, USA; Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Robert Yao RJ, Fordyce CB. Optimal transfusion threshold for anemic patients presenting with myocardial infarction and heart failure: dream or REALITY? Can J Cardiol 2024:S0828-282X(24)00299-X. [PMID: 38604338 DOI: 10.1016/j.cjca.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/01/2024] [Accepted: 04/04/2024] [Indexed: 04/13/2024] Open
Affiliation(s)
- Ren Jie Robert Yao
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for; Cardiovascular Innovation, University of British Columbia, Vancouver, BC
| | - Christopher B Fordyce
- Division of Cardiology, Department of Medicine, Vancouver General Hospital and Centre for; Cardiovascular Innovation, University of British Columbia, Vancouver, BC.
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Silvain J, Lattuca B, Puymirat E, Ducrocq G, Dillinger JG, Lhermusier T, Procopi N, Cachanado M, Drouet E, Abergel H, Danchin N, Montalescot G, Simon T, Steg PG. Impact of transfusion strategy on platelet aggregation and biomarkers in myocardial infarction patients with anemia. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2023; 9:647-657. [PMID: 37609995 DOI: 10.1093/ehjcvp/pvad055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/10/2023] [Accepted: 08/04/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND Higher rates of thrombotic events have been reported in myocardial infarction (MI) patients requiring blood transfusion. The impact of blood transfusion strategy on thrombosis and inflammation is still unknown. OBJECTIVE To compare the impact of a liberal vs. a restrictive transfusion strategy on P2Y12 platelet reactivity and biomarkers in the multicentric randomized REALITY trial. METHODS Patients randomized to a liberal (hemoglobin ≤10 g/dL) or a restrictive (hemoglobin ≤8 g/dL) transfusion strategy had VASP-PRI platelet reactivity measured centrally in a blinded fashion and platelet reactivity unit (PRU) measured locally using encrypted VerifyNow; at baseline and after randomization. Biomarkers of thrombosis (P-selectin, PAI-1, vWF) and inflammation (TNF-α) were also measured. The primary endpoint was the change in the VASP-PRI (difference from baseline and post randomization) between the randomized groups. RESULTS A total of 100 patients randomized were included in this study (n = 50 in each group). Transfused patients received on average 2.4 ± 1.6 units of blood. We found no differences in change of the VASP PRI (difference 1.2% 95% CI (-10.3-12.7%)) or by the PRU (difference 13.0 95% CI (-21.8-47.8)) before and after randomization in both randomized groups. Similar results were found in transfused patients (n = 71) regardless of the randomized group, VASP PRI (difference 1.7%; 95% CI (-9.5-1.7%)) or PRU (difference 27.0; 95% CI (-45.0-0.0)). We did not find an impact of transfusion strategy or transfusion itself in the levels of P-selectin, PAI-1, vWF, and TNF-α. CONCLUSION In this study, we found no impact of a liberal vs. a restrictive transfusion strategy on platelet reactivity and biomarkers in MI patients with anemia. A conclusion that should be tempered due to missing patients with exploitable biological data that has affected our power to show a difference.
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Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Group, INSERM UMRS1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris 75013, France
| | - Benoit Lattuca
- Cardiology Department, Nîmes University Hospital, Montpellier University, ACTION study group, Nîmes 30900, France
| | - Etienne Puymirat
- Université Paris-Cité, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), Paris 75015, France
| | - Gregory Ducrocq
- Université Paris-Cité, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris 75018, France
| | - Jean-Guillaume Dillinger
- Department of Cardiology, Inserm U942, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris, University Paris-Cité, Paris 75010, France
| | | | - Niki Procopi
- Sorbonne Université, ACTION Group, INSERM UMRS1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris 75013, France
| | - Marine Cachanado
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, Paris 75012, France
| | - Elodie Drouet
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, Paris 75012, France
| | - Helene Abergel
- Université Paris-Cité, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris 75018, France
| | - Nicolas Danchin
- Université Paris-Cité, AP-HP, Hôpital Européen Georges Pompidou, French Alliance for Cardiovascular Trials (FACT), Paris 75015, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Group, INSERM UMRS1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris 75013, France
| | - Tabassome Simon
- Department of Clinical Pharmacology-Clinical Research Platform (URCEST-CRB-CRCEST), AP-HP, Hôpital Saint Antoine, French Alliance for Cardiovascular Trials (FACT), Sorbonne-Université, Paris 75012, France
| | - Philippe Gabriel Steg
- Université Paris-Cité, AP-HP, French Alliance for Cardiovascular Trials (FACT), INSERM U1148, Paris 75018, France
- Institut Universitaire de France, Paris 75005, France
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Mistry N, Hare GMT, Shehata N, Belley‐Cote E, Papa F, Kramer RS, Saha T, Wijeysundera DN, Ko D, Verma S, Mazer CD. Transfusion Thresholds for Acute Coronary Syndromes-Insights From the TRICS-III Randomized Controlled Trial, Systematic Review, and Meta-Analysis. J Am Heart Assoc 2022; 12:e028497. [PMID: 36565203 PMCID: PMC9973586 DOI: 10.1161/jaha.122.028497] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Nikhil Mistry
- Department of AnesthesiaSt. Michael’s HospitalTorontoOntarioCanada,Institute of Medical SciencesUniversity of TorontoOntario
| | - Gregory M. T. Hare
- Department of AnesthesiaSt. Michael’s HospitalTorontoOntarioCanada,Department of Anesthesiology and Pain MedicineUniversity of TorontoOntarioCanada,Department of PhysiologyUniversity of TorontoOntarioCanada,Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
| | - Nadine Shehata
- Division of HematologySinai Health SystemTorontoOntarioCanada,Department of MedicineUniversity of TorontoOntarioCanada
| | - Emilie Belley‐Cote
- Population Health Research InstituteMcMaster University, Hamilton Health SciencesHamiltonOntario
| | - Fabio Papa
- Department of AnesthesiaSt. Michael’s HospitalTorontoOntarioCanada,Department of Anesthesiology and Pain MedicineUniversity of TorontoOntarioCanada
| | | | - Tarit Saha
- Department of Anesthesiology and Perioperative MedicineKingston General HospitalKingstonOntarioCanada
| | - Duminda N. Wijeysundera
- Department of AnesthesiaSt. Michael’s HospitalTorontoOntarioCanada,Department of Anesthesiology and Pain MedicineUniversity of TorontoOntarioCanada,Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
| | - Dennis Ko
- Schulich Heart Centre SunnybrookHealth Sciences CentreTorontoOntarioCanada
| | - Subodh Verma
- Institute of Medical SciencesUniversity of TorontoOntario,Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada,Division of Cardiac SurgerySt. Michael’s HospitalTorontoOntarioCanada,Department of SurgeryUniversity of TorontoOntarioCanada,Department of Pharmacology and ToxicologyUniversity of TorontoOntarioCanada
| | - C. David Mazer
- Department of AnesthesiaSt. Michael’s HospitalTorontoOntarioCanada,Institute of Medical SciencesUniversity of TorontoOntario,Department of Anesthesiology and Pain MedicineUniversity of TorontoOntarioCanada,Department of PhysiologyUniversity of TorontoOntarioCanada,Li Ka Shing Knowledge Institute of St. Michael’s HospitalTorontoOntarioCanada
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