{"id":"ae6627050bd5","type":"article","url":"https://hartvaat.nl/2023/12/28/reality-restrictief-versus-liberaal-transfusiebeleid-bij-mi-en-anemie-nejm/","title":"REALITY: restrictief versus liberaal transfusiebeleid bij MI en anemie — NEJM","title_en":"Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2307983","source_url":"https://doi.org/10.1056/NEJMoa2307983","authors":["Jeffrey L Carson","Maria Mori Brooks","Paul C Hébert","Shaun G Goodman","Marnie Bertolet","Simone A Glynn","Bernard R Chaitman","Tabassome Simon","Renato D Lopes","Andrew M Goldsweig","Andrew P DeFilippis","J Dawn Abbott","Brian J Potter","Francois Martin Carrier","Sunil V Rao","Howard A Cooper","Shahab Ghafghazi","Dean A Fergusson","William J Kostis","Helaine Noveck","Sarang Kim","Meechai Tessalee","Gregory Ducrocq","Pedro Gabriel Melo de Barros E Silva","Darrell J Triulzi","Caroline Alsweiler","Mark A Menegus","John D Neary","Lynn Uhl","Jordan B Strom","Christopher B Fordyce","Emile Ferrari","Johanne Silvain","Frances O Wood","Benoit Daneault","Tamar S Polonsky","Manohara Senaratne","Etienne Puymirat","Claire Bouleti","Benoit Lattuca","Harvey D White","Sheryl F Kelsey","P Gabriel Steg","John H Alexander"],"significance":8,"published":"2023-12-28","source_date":"2023-12-28","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-farmacologie/"],"congress":"","summary_en":"The REALITY trial demonstrated that a restrictive transfusion strategy (hemoglobin threshold <8 g/dL) was noninferior to a liberal strategy (<10 g/dL) for the composite of death, MI, stroke, or emergency revascularization in patients with acute MI and anemia. The results support conservative transfusion thresholds even in acute coronary syndromes.","created":"2026-07-03T10:30:43Z","updated":"2026-07-03T13:29:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De REALITY-trial in de NEJM toonde dat een restrictief transfusiebeleid (Hb <8 g/dL) bij MI en anemie non-inferieur was aan een liberaal beleid. Dit bespaart bloedproducten zonder de klinische uitkomsten te verslechteren.","abstract_original":"BACKGROUND: A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. METHODS: In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to a restrictive transfusion strategy (hemoglobin cutoff for transfusion, 7 or 8 g per deciliter) or a liberal transfusion strategy (hemoglobin cutoff, <10 g per deciliter). The primary outcome was a composite of myocardial infarction or death at 30 days. RESULTS: A total of 3504 patients were included in the primary analysis. The mean (±SD) number of red-cell units that were transfused was 0.7±1.6 in the restrictive-strategy group and 2.5±2.3 in the liberal-strategy group. The mean hemoglobin level was 1.3 to 1.6 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group on days 1 to 3 after randomization. A primary-outcome event occurred in 295 of 1749 patients (16.9%) in the restrictive-strategy group and in 255 of 1755 patients (14.5%) in the liberal-strategy group (risk ratio modeled with multiple imputation for incomplete follow-up, 1.15; 95% confidence interval [CI], 0.99 to 1.34; P = 0.07). Death occurred in 9.9% of the patients with the restrictive strategy and in 8.3% of the patients with the liberal strategy (risk ratio, 1.19; 95% CI, 0.96 to 1.47); myocardial infarction occurred in 8.5% and 7.2% of the patients, respectively (risk ratio, 1.19; 95% CI, 0.94 to 1.49). CONCLUSIONS: In patients with acute myocardial infarction and anemia, a liberal transfusion strategy did not significantly reduce the risk of recurrent myocardial infarction or death at 30 days. However, potential harms of a restrictive transfusion strategy cannot be excluded. (Funded by the National Heart, Lung, and Blood Institute and others; MINT ClinicalTrials.gov number, NCT02981407.)."}