Trial reportStroke2025
A Restrictive Versus a Liberal Transfusion Strategy in Patients With Spontaneous Intracerebral Hemorrhage: A Secondary Analysis of TRAIN Randomized Clinical Trial.
Chiara Faso, Elisa Gouvea Bogossian, Carla Bittencourt Rynkowski, Kirsten Moller, Piet Lormans, Manuel Quintana Diaz, Anselmo Caricato, Wojciech Dabrowski, Isabel Gonzalez Perez, Simona Steblaj and 18 more
Abstract readRandomized Controlled TrialMulticenter StudyClinical Trial, Phase III
In one paragraphTrial report in Stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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What it found
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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.
2 · The registryThe trial behind it
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3 · Its place in the literatureWho cites it
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4 · The recordCorrections and comments
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5 · Who and what moneyAuthors and funding
28 authors.
Chiara FasoDepartment of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (C.F., E.G.B., J.-L.V., F.S.T.).ORCID 0009-0008-7959-832X Elisa Gouvea Bogossian *Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (C.F., E.G.B., J.-L.V., F.S.T.).ORCID 0000-0002-2062-465X Carla Bittencourt RynkowskiIntensive Care Unit of Cristo Redentor Hospital, Porto Alegre, Brazil (C.B.R.).
Kirsten MollerDepartment of Neuroanaesthesiology and Neurosurgery, Neuroscience Centre, Copenhagen University, Hospital Rigshospitalet, Denmark (K.M.).ORCID 0000-0003-3058-1072 Manuel Quintana DiazDepartment of Intensive Care Medicine, Hospital Universitario de La Paz, Madrid, Spain (M.Q.D.).
Anselmo CaricatoInstitute of Anesthesiology and Intensive Care, Catholic University School of Medicine, Rome, Italy (A.C.).
Wojciech DabrowskiFirst Department of Anesthesiology and Intensive Care, Medical University of Lublin, Poland (W.D.).ORCID 0000-0003-0449-2375 Simona SteblajDepartment of Neurointensive Care, University Medical Centre Ljubljana, Slovenia (S.S.).
Herve QuintardDivision of Intensive Care Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care, and Emergency Medicine, Geneva University Hospital, Switzerland (H.Q.).
Pilar JustoHospital Universitario y Politécnico de La Fe, Valencia, Spain (P.J.).
Cassia RighyDepartment of Neurointensive Care, Instituto Estadual do Cerebro Paulo Niemeyer, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil (C.R.).ORCID 0000-0002-9206-9552 Olivier HuetDepartment of Anesthesia, Intensive Care Medicine and Peri-operative Medicine, CHRU de Brest, University of Bretagne Occidentale, Hôpital de la Cavale Blanche, Brest, France (O.H.).
Ata MahmoodpoorDepartment of Anesthesiology and Critical Care Medicine, Tabriz University of Medical Sciences, India (A.M.).ORCID 0000-0002-4361-6230 Aaron Blandino-OrtizDepartment of Intensive Care Medicine, Ramón y Cajal University Hospital, Universidad de Alcalá, Madrid, Spain (A.B.-O.).ORCID 0000-0002-3184-6418 Eija JunttilaDepartment of Anaesthesiology and Intensive Care, Tampere University Hospital, Finland (E.J.).ORCID 0000-0003-1546-9832 Nidya FunesHospital Zonal General de Agudos Dr. Alberto Edgardo Balestrini, Buenos Aires, Argentina (N.F.).ORCID 0009-0006-0732-3453 Luigi ZatteraDepartment of Anesthesiology and Intensive Care, Hospital Clìnic de Barcelona, Spain (L.Z.).ORCID 0000-0001-8967-8472 Angelo GiacomucciDepartment of Anesthesia and Intensive Care, Azienda Ospedaliera di Perugia, Italy (A.G.).ORCID 0000-0001-5660-889X Jamil DibuDepartment of Neurocritical Care, Cleveland Clinic Abu Dhabi, United Arab Emirates (J.D.).ORCID 0000-0002-0866-2194 Aurore RodriguesDepartment of Anesthesiology, Intensive Care and Perioperative Medicine, Bicetre Hospital Paris Saclay University, Assistance Publique Hôpitaux de Paris, Le Kremlin Bicêtre France (A.R.).ORCID 0000-0002-3360-0294 Pierre BouzatUniversité Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, France (P.B.).
Jean-Louis VincentDepartment of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (C.F., E.G.B., J.-L.V., F.S.T.).ORCID 0000-0001-6011-6951 Fabio Silvio Taccone *Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (C.F., E.G.B., J.-L.V., F.S.T.).ORCID 0000-0003-0830-1628 TRAIN Study Trial Group
Funding
No grant is acknowledged in the PubMed record.
6 · The paper itselfAbstract
backgroundRed blood cell transfusions are commonly administered to anemic patients with spontaneous intracerebral hemorrhage (ICH); however, the optimal hemoglobin threshold to initiate transfusion is uncertain in this population. Therefore, we aimed to assess the impact of 2 different hemoglobin thresholds to guide transfusion on the neurological outcome of anemic critically ill patients with ICH.
methodsThis is a secondary analysis of a prospective, multicenter, phase 3 randomized study conducted in 72 intensive care units across 22 countries from 2017 to 2022. Eligible patients for the original trial had an acute brain injury, hemoglobin values ≤9 g/dL within the first 10 days after admission, and an expected intensive care unit stay of at least 72 hours; in this study, only patients with spontaneous ICH were assessed. Patients were randomly assigned to undergo a restrictive (transfusion triggered by hemoglobin ≤7 g/dL) or a liberal (transfusion triggered by hemoglobin ≤9 g/dL) strategy over a 28-day period. The primary outcome was the occurrence of an unfavorable neurological outcome, defined as a Glasgow Outcome Scale Extended score of 1 to 5, at 180 days following randomization.
resultsA total of 144 patients with spontaneous ICH were analyzed: 45.8% of them were men with a mean age of 58.4 (SD, 13.4). Mean Glasgow Coma Scale on admission was 7.3 (SD, 3.3), and 75.7% of patients had a volume of hematoma >30 mL. Among all patients, 73 were randomized to the restrictive transfusion strategy, while 71 to the liberal one. Baseline characteristics were comparable between the 2 groups. At 180 days after randomization, patients assigned to the liberal transfusion strategy had a nonsignificant decrease in the probability of unfavorable neurological outcome (71.8 versus 84.7%; risk ratio, 0.85 [95% CI, 0.71-1.01];
conclusionsA liberal transfusion strategy was associated with a lower risk of mortality and organ failure, but not of unfavorable outcome in patients presenting with spontaneous ICH, compared with a restrictive strategy. However, the study cohort might have been underpowered to detect clinically relevant differences between the 2 interventions.
Indexed as
AnemiaBlood TransfusionCerebral HemorrhageErythrocyte TransfusionAgedFemaleHemoglobinsHumansIntensive Care UnitsMaleMiddle AgedProspective StudiesTreatment OutcomeHemoglobinsanemiabrain injurydisabilityintracerebral hemorrhagestroketransfusion
Identifiers
PMID40525290
PMCPMC12372721
What Socratic holds
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