Impact of transfusion strategy on platelet aggregation and biomarkers in myocardial infarction patients with anemia

Eur Heart J Cardiovasc Pharmacother. 2023 Nov 2;9(7):647-657. doi: 10.1093/ehjcvp/pvad055.

Abstract

Background: Higher rates of thrombotic events have been reported in myocardial infarction (MI) patients requiring blood transfusion. The impact of blood transfusion strategy on thrombosis and inflammation is still unknown.

Objective: To compare the impact of a liberal vs. a restrictive transfusion strategy on P2Y12 platelet reactivity and biomarkers in the multicentric randomized REALITY trial.

Methods: Patients randomized to a liberal (hemoglobin ≤10 g/dL) or a restrictive (hemoglobin ≤8 g/dL) transfusion strategy had VASP-PRI platelet reactivity measured centrally in a blinded fashion and platelet reactivity unit (PRU) measured locally using encrypted VerifyNow; at baseline and after randomization. Biomarkers of thrombosis (P-selectin, PAI-1, vWF) and inflammation (TNF-α) were also measured. The primary endpoint was the change in the VASP-PRI (difference from baseline and post randomization) between the randomized groups.

Results: A total of 100 patients randomized were included in this study (n = 50 in each group). Transfused patients received on average 2.4 ± 1.6 units of blood. We found no differences in change of the VASP PRI (difference 1.2% 95% CI (-10.3-12.7%)) or by the PRU (difference 13.0 95% CI (-21.8-47.8)) before and after randomization in both randomized groups. Similar results were found in transfused patients (n = 71) regardless of the randomized group, VASP PRI (difference 1.7%; 95% CI (-9.5-1.7%)) or PRU (difference 27.0; 95% CI (-45.0-0.0)). We did not find an impact of transfusion strategy or transfusion itself in the levels of P-selectin, PAI-1, vWF, and TNF-α.

Conclusion: In this study, we found no impact of a liberal vs. a restrictive transfusion strategy on platelet reactivity and biomarkers in MI patients with anemia. A conclusion that should be tempered due to missing patients with exploitable biological data that has affected our power to show a difference.

Keywords: Anemia; Myocardial infarction; Platet Reactivity; Transfusion.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anemia*
  • Biomarkers
  • Blood Transfusion
  • Hemoglobins
  • Humans
  • Inflammation
  • Myocardial Infarction*
  • P-Selectin
  • Plasminogen Activator Inhibitor 1
  • Platelet Aggregation
  • Thrombosis*
  • Tumor Necrosis Factor-alpha
  • von Willebrand Factor

Substances

  • P-Selectin
  • Plasminogen Activator Inhibitor 1
  • Tumor Necrosis Factor-alpha
  • von Willebrand Factor
  • Hemoglobins
  • Biomarkers