Transfusion Strategies for Acute Upper Gastrointestinal Bleeding

A randomized clinical trial shows that among patients with upper GI bleeding, withholding transfusion until the hemoglobin level falls below 7 g per deciliter results in better outcomes than using 9 g per deciliter as the trigger for transfusion. Acute upper gastrointestinal bleeding is a common emergency condition associated with high morbidity and mortality. 1 It is a frequent indication for red-cell transfusion, because acute blood loss can decrease tissue perfusion and the delivery of oxygen to tissues. Transfusion may be lifesaving in patients with massive exsanguinating bleeding. However, in most cases hemorrhage is not so severe, and in such circumstances the safest and most effective transfusion strategy is controversial. 2 , 3 Restricted transfusion strategies may be appropriate in some settings. Controlled trials have shown that for critically ill patients, a restrictive transfusion strategy is at least as effective as a . . .