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February 9, 2005

Blood Transfusion in Patients With Acute Coronary Syndrome—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(6):673-674. doi:10.1001/jama.293.6.673-b

In Reply: Mr Rathore and Drs Radford and Krumholz express concern about our conclusions, which differ from those of their study.1 While both studies find that transfusion for a hematocrit value of 36% or more is associated with increased mortality, their study suggests that transfusion for a hematocrit below 30% is associated with decreased mortality. We could not identify a hematocrit threshold below which transfusion was beneficial, but we found that transfusion for a hematocrit greater than 25% was associated with harm. Therefore, the issue is not whether blood transfusion is harmful but the inflection point at which it is associated with harm. Of the 2 studies they cite in support of liberal transfusion, one is an observational study that found a benefit of transfusion only in an unadjusted analysis of 202 patients with a “cardiovascular diagnosis” and an Acute Physiology and Chronic Health Evaluation score of more than 20,2 and the other is a subgroup analysis of a randomized trial that included only 77 patients with unstable angina or myocardial infarction.3

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