Feb 10, 2021
REALITY results show restrictive transfusions noninferior to liberal transfusions
Restrictive transfusion for patients with acute myocardial infarction (AMI) and anemia is noninferior to a liberal transfusion strategy in the incidence of major adverse cardiovascular events (MACE), according to results from the open-label, randomized Restrictive and Liberal Transfusion Strategies in Patients with Acute Myocardial Infarction (REALITY) trial.
“Anemia is common in patients with AMI and is associated with worse clinical outcomes. In theory, transfusion should increase oxygen delivery, which would argue for a liberal transfusion strategy in patients with acute myocardial ischemia. However, data suggest that oxygen delivery is not necessarily increased in patients receiving transfusions, due to red blood cell depletion in nitric oxide and 2,3-diphosphoglyceric acid during storage, and that, conversely, transfusion may increase platelet activation and aggregation and produc