Meta-Analysis
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World J Gastroenterol. Oct 28, 2013; 19(40): 6919-6927
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6919
Restrictive vs liberal transfusion for upper gastrointestinal bleeding: A meta-analysis of randomized controlled trials
Juan Wang, Yong-Xin Bao, Ming Bai, Yong-Guo Zhang, Wen-Da Xu, Xing-Shun Qi
Juan Wang, Xing-Shun Qi, Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Shenyang 110042, Liaoning Province, China
Yong-Xin Bao, Post-doctoral Research Station, Shenyang General Hospital of Chinese PLA, Shenyang 110016, Liaoning Province, China
Ming Bai, Xing-Shun Qi, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi’an 710032, Shaanxi Province, China
Yong-Guo Zhang, Wen-Da Xu, Department of Gastroenterology, Shenyang General Hospital of Chinese PLA, Shenyang 110016, Liaoning Province, China
Author contributions: Qi XS is the guarantor of the study; Wang J and Qi XS designed the study and performed literature retrieval and data collection; Wang J, Bao YX, Bai M, Zhang YG, Xu WD and Qi XS analyzed the data and interpreted the results; Wang J and Qi XS drafted the paper; Wang J, Bao YX, Bai M, Zhang YG, Xu WD and Qi XS revised the paper.
Correspondence to: Xing-Shun Qi, MD, Department of Gastroenterology, No. 463 Hospital of Chinese PLA, Dadong Xiaohe Yan Road 46, Shenyang 110042, China. xingshunqi@126.com
Telephone: +86-24-28845200 Fax: +86-24-24835206
Received: July 9, 2013
Revised: August 16, 2013
Accepted: September 4, 2013
Published online: October 28, 2013
Abstract

AIM: To compare the outcome of upper gastrointestinal bleeding (UGIB) between patients receiving restrictive and liberal transfusion.

METHODS: PubMed, EMBASE, and Cochrane Library databases were employed to identify all relevant randomized controlled trials regarding the outcome of UGIB after restrictive or liberal transfusion. Primary outcomes were death and rebleeding. Secondary outcomes were length of hospitalization, amount of blood transfused, and hematocrit and hemoglobin at discharge or after expansion.

RESULTS: Overall, 4 papers were included in this meta-analysis. The incidence of death was significantly lower in patients receiving restrictive transfusion than those receiving liberal transfusion (OR: 0.52, 95%CI: 0.31-0.87, P = 0.01). The incidence of rebleeding was lower in patients receiving restrictive transfusion than those receiving liberal transfusion, but this difference did not reach any statistical significance (OR: 0.26, 95%CI: 0.03-2.10, P = 0.21). Compared with those receiving liberal transfusion, patients receiving restrictive transfusion had a significantly shorter length of hospitalization (standard mean difference: -0.17, 95%CI: -0.30--0.04, P = 0.009) and a significantly smaller amount of blood transfused (standard mean difference: -0.74, 95%CI: -1.15--0.32, P = 0.0005) with a lower hematocrit and hemoglobin level at discharge or after expansion.

CONCLUSION: Restrictive transfusion should be employed in patients with UGIB.

Keywords: Upper gastrointestinal bleeding, Blood transfusion, Meta-analysis, Randomized controlled trial

Core tip: Current international consensus recommends restrictive transfusion for upper gastrointestinal bleeding. However, this recommendation is largely based on expert opinions. We have performed the present meta-analysis of randomized controlled trials, which potentially supported the superiority of restrictive over liberal transfusion for upper gastrointestinal bleeding.