Researchers recently investigated the effects of liberal versus restrictive red-cell transfusion strategies in patients with aneurysmal subarachnoid hemorrhage and anemia.

The Subarachnoid Hemorrhage Red Cell Transfusion Strategies and Outcome (SAHaRA) trial involved 742 critically ill patients with acute aneurysmal subarachnoid hemorrhage (SAH) and anemia; they were randomly assigned to undergo either a liberal strategy (transfusion at hemoglobin levels of 10 g/dL or lower) or a restrictive strategy (transfusion at 8 g/dL or lower). Results of the trial were published in The New England Journal of Medicine.

The researchers found no significant difference in neurologic outcomes at 12 months between the two strategies. An unfavorable neurologic outcome, defined as a modified Rankin scale score of 4 or higher, occurred in 33.5% of patients in the liberal group compared to 37.7% in the restrictive group, yielding a risk ratio of 0.88 (95% confidence interval [CI] = 0.72–1.09, P = .22).

Secondary outcomes included functional independence, measured by the Functional Independence Measure (FIM), and quality of life, assessed using the EuroQol five-dimension, five-level (EQ-5D-5L) utility index. The mean FIM score was 82.8 in the liberal group and 79.8 in the restrictive group, with a mean difference of 3.01 (95% CI = –5.49 to 11.51). The EQ-5D-5L utility index score was 0.5 in both groups, indicating no significant difference in quality of life.

Researchers also reported similar rates of adverse events between the two groups, with no unexpected complications arising from the transfusion strategies. The incidence of new radiographic vasospasm was 31.5% in the liberal group compared to 40.7% in the restrictive group, with a risk ratio of 0.77 (95% CI = 0.63–0.95).

"In patients with aneurysmal [SAH] and anemia, a liberal strategy of red-cell transfusion did not result in a lower risk of an unfavorable neurologic outcome at 12 months than a restrictive strategy," wrote lead author Shane W. English, MD, of Ottawa Hospital Research Institute, and colleagues.

Conducted across 23 centers in Canada, Australia, and the United States, the trial was funded by peer-reviewed grants from various health research organizations, contributing to the ongoing discussion regarding optimal transfusion practices in critically ill patients with SAH.

The authors reported no conflicts of interest.