A new study led by Rutgers Health highlights the potential life-saving benefits of providing more blood to anemic patients recovering from heart attacks. Published in NEJM Evidence, the research consolidates findings from four clinical trials involving over 4,300 patients and suggests that a liberal blood transfusion strategy may significantly reduce mortality rates, especially six months after a heart attack.

This recent analysis builds upon a pivotal 2023 study known as the MINT trial (Myocardium Infarction and Transfusion), also led by Jeffrey L. Carson, provost and Distinguished Professor of Medicine at Rutgers Robert Wood Johnson Medical School. The MINT trial found that anemic heart attack patients who received fewer blood transfusions experienced higher mortality rates or recurrent heart attacks compared to those who received more blood.

Reflecting on these results, Carson collaborated with researchers in France and the United States to conduct a larger study that pooled data from four clinical trials. This meta-analysis involved 4,311 heart attack patients with low blood counts, half of whom followed a restrictive transfusion strategy (receiving less blood), while the other half adhered to a liberal strategy (receiving more blood).

The study focused on two critical outcomes: mortality or recurrent heart attack within 30 days and all-cause mortality at six months. While the differences in outcomes at 30 days were not statistically significant, the findings at six months provided important insights.

At 30 days, death occurred in 9.3% of patients in the restrictive strategy group compared to 8.1% in the liberal group (Relative Risk [RR]: 1.15, Confidence Interval [CI]: 0.95–1.39).

Cardiac deaths at 30 days were significantly higher in the restrictive group at 5.5%, compared to 3.7% in the liberal group (RR: 1.47, 95% CI: 1.11–1.94).

At six months, all-cause mortality was 20.5% in the restrictive strategy group versus 19.1% in the liberal group (Hazard Ratio: 1.08, 95% CI: 1.05–1.11).

"The results of this analysis show that giving more blood to anemic patients with heart attacks can save lives at six months," Carson said.

The study included patients with a range of pre-existing conditions, such as prior heart attacks, heart failure, diabetes, or kidney disease. The average age of participants was 72 years, and 45% were women. This diverse patient population reflects the high-risk nature of anemic heart attack patients and underscores the importance of effective treatment strategies.

A key aspect of the study was comparing the two transfusion strategies. The liberal approach involved administering more blood, which resulted in a slightly lower rate of death or recurrent heart attack within 30 days (13.8%) compared to the restrictive approach (15.4%).

However, the long-term outcomes were more telling. The six-month mortality rate was notably lower in the liberal transfusion group, suggesting that the benefits of providing more blood extend beyond the immediate recovery period.

Interestingly, the incidence of heart failure was similar in both groups (RR: 0.89, 95% CI: 0.70–1.13), indicating that the liberal transfusion strategy did not increase the risk of this complication.

This study provides valuable insights for clinicians managing anemic heart attack patients. While the restrictive transfusion strategy has often been preferred to minimize potential risks associated with blood transfusions, this research highlights the potential life-saving benefits of a more liberal approach.

The data underscores that while the immediate risk of recurrent heart attacks or mortality may not differ significantly, the long-term survival advantage of liberal transfusions cannot be ignored.

Carson and his team emphasize the need for further research to refine transfusion strategies. "By combining data from multiple trials, we’ve been able to generate more precise estimates of treatment effects," Carson said. The findings pave the way for future studies that could help tailor transfusion approaches to individual patient needs, moving closer to precision medicine in cardiology.

The Rutgers-led study, supported by a comprehensive meta-analysis, challenges conventional restrictive transfusion strategies for anemic heart attack patients. By highlighting the long-term survival benefits of liberal transfusions, it sets the stage for a shift in clinical practices aimed at improving outcomes for high-risk patients.

As the medical community continues to weigh the risks and benefits of transfusion strategies, this research provides a compelling case for a more patient-centered approach, ensuring that anemic heart attack patients receive the best possible care to enhance their recovery and survival.