Restrictive transfusion hemoglobin (Hb) thresholds are currently recommended across multiple medical and surgical settings, but the optimal RBC transfusion threshold for patients with acute myocardial infarction (AMI) is unclear. Three of four randomized controlled trials with patients with AMI, including the Myocardial Ischemia and Transfusion (MINT) trial with 3504 participants, suggest that liberal transfusion hemoglobin thresholds may reduce mortality for patients with AMI. Based on a meta-analysis from four trials (n=4311), the AABB updated their guidelines. The AABB recommends a liberal RBC transfusion for hospitalized patients with AMI when hemoglobin falls below 10 g/dL (conditional recommendation, low-certainty evidence). A liberal transfusion strategy with a hemoglobin threshold of 10 g/dL resulted in 1.2% fewer deaths compared to a restrictive transfusion threshold of 7-8 g/dL. This new recommendation does not apply to patients without AMI. Future research should address optimal thresholds according to the type of myocardial infarction and other patient characteristics.
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