Prospective, randomized trial of higher goal hemoglobin after subarachnoid hemorrhage

Neurocrit Care. 2010 Dec;13(3):313-20. doi: 10.1007/s12028-010-9424-4.

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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anemia / blood*
  • Anemia / epidemiology
  • Anemia / therapy*
  • Cerebral Infarction / blood
  • Cerebral Infarction / epidemiology
  • Cerebral Infarction / pathology
  • Critical Care / methods
  • Critical Care / statistics & numerical data
  • Erythrocyte Transfusion*
  • Female
  • Hemoglobins / metabolism*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pilot Projects
  • Prospective Studies
  • Risk Factors
  • Subarachnoid Hemorrhage / blood*
  • Subarachnoid Hemorrhage / epidemiology
  • Subarachnoid Hemorrhage / pathology
  • Treatment Outcome
  • Vasospasm, Intracranial / blood
  • Vasospasm, Intracranial / epidemiology
  • Vasospasm, Intracranial / pathology

Substances

  • Hemoglobins