Yayın : DGNews

Yayın Yılı : 2014

Pubmed Linki : http://www.docguide.com/maintaining-high-haemoglobin-levels-does-not-improve-neurological-outcomes-after-tbi?tsid=5

Konu : Transfüzyon

Literatür İçeriği :  CHICAGO -- July 1, 2014 -- In patients with a traumatic brain injury (TBI), neither the administration of the hormone erythropoietin (EPO) nor maintaining a higher haemoglobin concentration through blood transfusion resulted in improved neurological outcome at 6 months, according to a study published in the July 2 issue of JAMA.

Transfusing at higher haemoglobin concentrations was associated with a higher risk of adverse events.

Patients with severe TBI commonly develop anaemia. For patients with neurological injury, anaemia is a potential cause of secondary injury, which may worsen neurological outcomes. There is limited information about the effect of erythropoietin or a high haemoglobin transfusion threshold after a TBI.

Claudia S. Robertson, MD, Baylor College of Medicine, Houston, Texas, and colleagues conducted a randomised clinical trial that included 200 patients (erythropoietin, n = 102; placebo, n = 98) with a closed head injury at neurosurgical intensive care units in 2 US level 1 trauma centres between May 2006 and August 2012. Patients were enrolled within 6 hours of injury and had to be unable to follow commands after initial stabilisation.

Erythropoietin or placebo was initially dosed daily for 3 days and then weekly for 2 more weeks (n = 74). There were 99 patients assigned to a haemoglobin transfusion threshold of 7 g/dL and 101 patients assigned to 10 g/dL.

In the placebo group, 34 patients (38.2%) recovered to a favourable outcome -- defined as good recovery and moderate disability, as measured by a functional assessment inventory -- compared with 17 patients (48.6%) in the erythropoietin 1 group (first dosing regimen) and 17 patients (29.8%) in the erythropoietin 2 group (second dosing regimen).

Thirty-seven patients (42.5%) assigned to the transfusion threshold of 7 g/dL recovered to a favourable outcome compared with 31 patients (33.0%) assigned to the transfusion threshold of 10 g/dL.

There was a higher incidence of thromboembolic events for the transfusion threshold of 10 g/dL (21.8%) versus (8.1%) for the threshold of 7 g/dL.

“Among patients with closed head injury, neither the administration of erythropoietin nor maintaining haemoglobin concentration of at least 10 g/dL resulted in improved neurological outcome at 6 months,” the authors wrote. “These findings do not support either approach in patients with traumatic brain injury.”

SOURCE: JAMA

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