Trial reportCritical care (London, England)2025
Liberal versus restrictive transfusion strategies in subarachnoid hemorrhage: a secondary analysis of the TRAIN study.
Trial report in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02968654 (Transfusion Strategies in Acute Brain Injured Patients. A Prospective Multicenter Randomized Study.), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Transfusion Strategies in Acute Brain Injured Patients. A Prospective Multicenter Randomized Study.
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Liberal versus restrictive red blood cell transfusion thresholds in acute acquired brain injury: a systematic review and meta-analysis.BMJ open · 2025Pooled it
- Timing of Transfusion Strategy Initiation in Acute Brain Injury: A Subanalysis of the TRAIN Study.Neurocritical care · 2026Article
- Perioperative anemia and patient blood management in neurosurgery and neurocritical care: a narrative review.Journal of anesthesia, analgesia and critical care · 2026Review
- Liberal Versus Restrictive Blood Transfusion Strategies in Neurocritical Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Critical care research and practice · 2026Article
- Post-traumatic vasospasm: Epidemiology, specificities, risk factors, and therapeutics.Journal of intensive medicine · 2025Review
- Beyond the bleed: complications after aneurysmal subarachnoid hemorrhage. Pathophysiology, clinical implications, and management strategies: a review.Critical care (London, England) · 2025Review
- Liberal Versus Restrictive Transfusion Strategy in Patients With Subarachnoid Hemorrhage: A Meta-Analysis.Stroke (Hoboken, N.J.) · 2025Article
- Transfusion practice in elderly patients across surgical disciplines in Germany - a secondary data analysis of over 21 million patients.Blood transfusion = Trasfusione del sangueArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
27 authors.
Funding
Abstract
backgroundThe optimal hemoglobin (Hb) threshold to trigger red blood cell transfusions (RBCT) in subarachnoid hemorrhage (SAH) patients is unclear. This study evaluated the impact of liberal versus restrictive transfusion strategies on neurological outcome in patients with SAH.
methodsThis is a pre-planned secondary analysis of the "TRansfusion Strategies in Acute brain INjured Patients" (TRAIN) study. We included all SAH patients from the original study that were randomized to receive RBCT when Hb levels dropped below 9 g/dL (liberal group) or 7 g/dL (restrictive group). The primary outcome was an unfavorable neurological outcome at 180 days, defined by a Glasgow Outcome Scale Extended score of 1-5.
resultsOf the 190 SAH patients in the trial, 188 (98.9%) had data available for the primary outcome, with 86 (45.3%) in the liberal group and 102 (53.6%) in the restrictive group. Patients in the liberal group were older than in the restrictive group, but otherwise had similar baseline characteristics. Patients in the liberal group received more RBCT and showed higher Hb levels over time. At 180 days, 57 (66.3%) patients in the liberal group and 78 (76.4%) in the restrictive group had unfavorable outcomes (risk ratio, RR 0.87; 95% confidence intervals, 95% CI 0.71-1.04). Patients in the liberal group had a significantly lower risk of cerebral ischemia (RR 0.63; 95% CI 0.41-0.97). In a multivariate analysis, randomization to the liberal group was associated with a lower risk of unfavorable outcome (RR 0.83, 95% CI 0.70-0.99).
conclusionsA liberal transfusion strategy was not associated with a lower incidence of unfavorable outcome after SAH when compared to a restrictive strategy. However, in a multivariable analysis adjusted for confounders randomization to the liberal group was associated with lower risk of unfavorable outcome. The occurrence of cerebral ischemia was significantly lower in the liberal transfusion strategy group.
trial registrationClinicalTrials.gov number-NCT02968654 registered on November 16th, 2016.
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