Abstract Details

Title Liberal vs Restrictive Blood Transfusion Strategies in Neurocritical Care With Acute Brain Injury: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Topic Neuro Trauma and Critical Care

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 19-009

Objective To compare the effects of restrictive versus liberal transfusion thresholds on mortality, neurological outcomes, and complications in adult neurocritical care patients.

Background Neurocritical patients with traumatic brain injury, subarachnoid hemorrhage, or intracerebral hemorrhage often develop anemia that compromises brain oxygen delivery and worsens outcomes. Both liberal and restrictive blood transfusion strategies are used to manage anemia in these patients, but the optimal approach remains unclear due to inconsistent evidence and limited neuro-specific analyses.

Design/Methods A systematic search of PubMed, Cochrane Library, ScienceDirect, and Google Scholar (inception–December 2024) identified randomized controlled trials comparing restrictive and liberal transfusion strategies in adult neurocritical care, following PRISMA guidelines. Outcomes included mortality, Glasgow Outcome Scale (GOS), transfusion volume, sepsis, ICU/hospital length of stay, and secondary complications. The study is registered with PROSPERO (CRD42025635426).

Results Seven randomized controlled trials including 1,941 neurocritical care patients were analyzed. Restrictive transfusion strategies significantly reduced transfusion requirements and sepsis risk without adversely impacting mortality or neurological outcomes. Patients in the restrictive group received fewer red blood cell (RBC) units (mean difference = 2.36; 95% CI 1.08–3.64; P = 0.0003) and had a lower incidence of sepsis (risk ratio = 0.73; 95% CI 0.56–0.96; P = 0.02). Mortality at ICU, in-hospital, 30-day, 6-month, and long-term follow-up, as well as GOS at six months, showed no significant differences (all P > 0.05). ICU and hospital length of stay and secondary neurological or systemic complications were comparable.

Conclusions Restrictive transfusion strategies are as effective as liberal approaches, achieving similar mortality and neurological outcomes while minimizing transfusion requirements and infection risk. Restrictive thresholds represent a safe, resource-efficient approach that preserves neurological outcomes and supports evidence-based transfusion practices. Future studies should identify patient-specific hemoglobin targets to optimize cerebral oxygenation and neurologic recovery.

Authors/Disclosures
Anoosh Farooqui, MD, MBBS, MPH PRESENTER	Dr. Farooqui has nothing to disclose.
Noor Naeem, MBBS	Miss Naeem has nothing to disclose.
Ayesha Shaukat, MBBS	Dr. Shaukat has nothing to disclose.
Muhammad Ahmed, MBBS	Dr. Ahmed has nothing to disclose.
Komal Khan, MBBS	Miss Khan has nothing to disclose.
Aiman Shahid Khan, MBBS	Miss Shahid Khan has nothing to disclose.
Rubaisha Saleem, MBBS	Ms. Saleem has nothing to disclose.
Anupama Ariyasiri, MBBS	Miss Ariyasiri has nothing to disclose.
Syed Abdul Aziz Jameel, MBBS	Mr. Jameel has nothing to disclose.
Shahab Afridi, MBBS	Mr. Afridi has nothing to disclose.
Javeria Salman, MBBS	Miss Salman has nothing to disclose.
Marib Ashraf, MBBS	Mr. Ashraf has nothing to disclose.
Amamah R. Chaudhry, MBBS	Ms. Chaudhry has nothing to disclose.
Zobia Ahmad, Medical Student	Ms. Ahmad has nothing to disclose.
Muhammad Omar Larik (Dow International Medical College)	Mr. Larik has nothing to disclose.
Muhammad Hasanain, MD	Dr. Hasanain has nothing to disclose.
Muhammad Umair Anjum, MBBS	Dr. Anjum has nothing to disclose.

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