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February 9, 2005

Blood Transfusion in Patients With Acute Coronary Syndrome

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

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 coronary syndromes.

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