Letters Section Editor: Robert M. Golub,
MD, Senior Editor.
To the Editor: We are concerned by the conclusion
of the study by Dr Rao and colleagues1 that
use of blood transfusion in patients with acute coronary syndromes is associated
with higher mortality. The results are inconsistent with previous studies
of transfusion use in patients with ischemic heart disease. Our previous study2 of 78 974 Medicare beneficiaries hospitalized
with myocardial infarction (which used medical record data, not administrative
billing data as was suggested in the article) demonstrated a mortality reduction
associated with transfusion use in patients with a hematocrit of 30% or less.
Moreover, our findings are similar to an earlier report of a transfusion-associated
survival benefit in patients with ischemic heart disease.3 The
3 randomized studies4- 6 cited
as evidence of no transfusion benefit enrolled 25, 38, and 99 patients, respectively,
and thus may have been insufficiently powered to detect any survival difference.
In contrast, the largest randomized controlled trial of transfusion in patients
with cardiovascular disease7 suggested that
restrictive use of transfusions may be harmful in patients experiencing acute
Rathore SS, Radford MJ, Krumholz HM. Blood Transfusion in Patients With Acute Coronary Syndrome. JAMA. 2005;293(6):673-674. doi:10.1001/jama.293.6.673-a