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Prospective, Randomized Trial of Higher Goal Hemoglobin after Subarachnoid Hemorrhage

Abstract

Background and Purpose

In patients with subarachnoid hemorrhage (SAH), higher hemoglobin (HGB) has been associated with better outcomes, but packed red blood cell (PRBC) transfusions with worse outcomes. We performed a prospective pilot trial of goal HGB after SAH.

Methods

Forty-four patients with SAH and high risk for vasospasm were randomized to goal HGB concentration of at least 10 or 11.5 g/dl. We obtained blinded clinical outcomes at 14 days (NIH Stroke Scale and modified Rankin Scale, mRS), 28 days (mRS), and 3 months (mRS), and blinded interpretation of brain MRI for cerebral infarction at 14 days. This trial is registered at www.stroketrials.org.

Results

Forty-four patients were randomized. Patients with goal HGB 11.5 g/dl received more PRBC units per transfusion [1 (1–2) vs. 1 (1–1), P < 0.001] and more total PRBC units [3 (2–4) vs. 2 (1–3), P = 0.045]. Prospectively defined safety endpoints were not different between groups. HGB concentration was different between study groups from day 4 onwards. The number of cerebral infarctions on MRI (6 of 20 vs. 9 of 22), NIH Stroke Scale scores at 14 days [1 (0–9.75) vs. 2 (0–16)], and rates of independence on the mRS at 14 days (65% vs. 44%) and 28 days (80% vs. 67%) were similar, but favored higher goal HGB (P > 0.1 for all).

Conclusions

Higher goal hemoglobin in patients with SAH seems to be safe and feasible. A phase III trial of goal HGB after SAH is warranted.

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Acknowledgments and Fundings

This study was funded by grants to AMN from the Neurocritical Care Society, supported by NovoNordisk (for partial salary support) and from the Northwestern Memorial Foundation for MRI scans and additional PRBC transfusions above usual care. Periodic updates were sent to the Neurocritical Care Society, but study sponsors had no role in the design of the protocol, selection of patients, collection of data, statistical analysis, or decision to submit for publication. AMN is listed as a Co-Investigator for the proposed study Transfusion in Subarachnoid Hemorrhage (PI: Peter D LeRoux), and some of these data have been used to plan it. The grant has not yet been submitted, and there has been no compensation (financial or otherwise) for that study.

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Correspondence to Andrew M. Naidech.

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Naidech, A.M., Shaibani, A., Garg, R.K. et al. Prospective, Randomized Trial of Higher Goal Hemoglobin after Subarachnoid Hemorrhage. Neurocrit Care 13, 313–320 (2010). https://doi.org/10.1007/s12028-010-9424-4

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  • DOI: https://doi.org/10.1007/s12028-010-9424-4

Keywords

  • Subarachnoid hemorrhage
  • Anemia
  • Transfusion
  • Outcomes