A conservative transfusion strategy for acute upper gastrointestinal bleeding appears to confer a greater survival benefit than liberal treatment, according to a New England Journal of Medicine study.

Investigators randomized some 900 patients either to a conservative strategy (transfusion when hemoglobin fell below 7 g/dL) or to a liberal strategy (transfusion when hemoglobin fell below 9). About half those treated conservatively received transfusions, as opposed to 85% of those assigned to the liberal strategy.

Those on conservative treatment showed a 45% relative risk reduction in all-cause mortality at 45 days (absolute mortality, 5% vs. 9% on liberal treatment). Similarly, further bleeding was less frequent on conservative treatment, as was the rate of adverse events. However, patients with severe cirrhosis (Child-Pugh class C) did not show a survival benefit.

An editorialist, noting that the findings “justify current recommendations,” concludes that “most patients with upper gastrointestinal bleeding, with or without portal hypertension, should have blood transfusions withheld until the hemoglobin level drops below 7.”

Source: NEJM