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Blood transfusion safe, possibly beneficial in acute decompensated heart failure

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Blood transfusion is safe and may be beneficial in patients with acute decompensated heart failure, say researchers from Israel in the October American Heart Journal.

Because of the adverse affects of anemia in acute decompensated heart failure, blood transfusions are often given. However, the authors explain, the safety and efficacy of transfusion for such patients are uncertain.

Dr. Moshe Garty from Rabin Medical Center in Petah Tiqwa and colleagues evaluated the impact of transfusion on short- and long-term outcomes in 2335 patients with acute decompensated heart failure.

The 166 patients who received transfusions were older, more likely to be female, more likely to have diabetes and renal failure, and more likely to be receiving inotropic support, according to the article. Nadir hemoglobin levels were below 10 g/dL in 92.7% of blood transfusion patients, compared with only 8.0% of non-blood transfusion patients.

After adjustment, short-term mortality for transfused patients tended to be lower than for non-transfused patients, but there was no difference in long-term mortality.

Similarly, in a propensity analysis of 103 “very well matched” pairs of patients, the short-term mortality for patients receiving blood transfusion tended to be lower, whereas the 4-year survival was similar, at less than 40%, in both groups.

“We focused on patients who were not hemodynamically stable,” the investigators say. “Thus, our findings actually reinforce the current American College of Surgery guidelines of reserving blood transfusion only for severely anemic patients or those who are hemodynamically unstable.”

“Our data alleviate concerns that such therapy may exacerbate outcomes and indeed suggest that it might even improve short-term outcomes, provided blood transfusion is given under vigilant supervision, perhaps at slower infusion rates and with concurrent administration of diuretics,” the authors conclude.

Am Heart J 2009;158:653-658.