Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

Vipul Jairath; Brennan C. Kahan; Alasdair Gray; Caroline J. Dore; Ana Mora; Claire Dyer; Elizabeth A. Stokes; Charlotte Llewelyn; Adam A. Bailey; Helen Dallal; Simon M. Everett; Martin W. James; Adrian J. Stanley; Nicholas Church; Melanie Darvvent; John Greenaway; Ivan Le Jeune; Ian Reckless; Helen E. Campbell; Sarah Meredith; Kelvin R. Palmer; Richard F. A. Logan; Simon P. L. Travis; Timothy S. Walsh; Michael F. Murphy

doi:10.1016/j.tmrv.2013.04.001

Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

Vipul Jairath^*, Brennan C. Kahan, Alasdair Gray, Caroline J. Dore, Ana Mora, Claire Dyer, Elizabeth A. Stokes, Charlotte Llewelyn, Adam A. Bailey, Helen Dallal, Simon M. Everett, Martin W. James, Adrian J. Stanley, Nicholas Church, Melanie Darvvent, John Greenaway, Ivan Le Jeune, Ian Reckless, Helen E. Campbell, Sarah MeredithKelvin R. Palmer, Richard F. A. Logan, Simon P. L. Travis, Timothy S. Walsh, Michael F. Murphy

^*Corresponding author for this work

Research output: Contribution to journal › Literature review › peer-review

Abstract

Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is

Original language	English
Pages (from-to)	146-153
Number of pages	8
Journal	Transfusion medicine reviews
Volume	27
Issue number	3
DOIs	https://doi.org/10.1016/j.tmrv.2013.04.001
Publication status	Published - Jul 2013

Keywords / Materials (for Non-textual outputs)

CRITICALLY-ILL PATIENTS
RED-CELL TRANSFUSION
HEALTH RESEARCH
CLINICAL-OUTCOMES
CARDIAC-SURGERY
HEMORRHAGE
REQUIREMENTS
MANAGEMENT
THRESHOLD
MORTALITY

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10.1016/j.tmrv.2013.04.001

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Jairath, V., Kahan, B. C., Gray, A., Dore, C. J., Mora, A., Dyer, C., Stokes, E. A., Llewelyn, C., Bailey, A. A., Dallal, H., Everett, S. M., James, M. W., Stanley, A. J., Church, N., Darvvent, M., Greenaway, J., Le Jeune, I., Reckless, I., Campbell, H. E., ... Murphy, M. F. (2013). Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial. Transfusion medicine reviews, 27(3), 146-153. https://doi.org/10.1016/j.tmrv.2013.04.001

@article{a77c94687a7d423fb6cf1ff050f2533c,

title = "Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial",

abstract = "Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is ",

keywords = "CRITICALLY-ILL PATIENTS, RED-CELL TRANSFUSION, HEALTH RESEARCH, CLINICAL-OUTCOMES, CARDIAC-SURGERY, HEMORRHAGE, REQUIREMENTS, MANAGEMENT, THRESHOLD, MORTALITY",

author = "Vipul Jairath and Kahan, {Brennan C.} and Alasdair Gray and Dore, {Caroline J.} and Ana Mora and Claire Dyer and Stokes, {Elizabeth A.} and Charlotte Llewelyn and Bailey, {Adam A.} and Helen Dallal and Everett, {Simon M.} and James, {Martin W.} and Stanley, {Adrian J.} and Nicholas Church and Melanie Darvvent and John Greenaway and {Le Jeune}, Ivan and Ian Reckless and Campbell, {Helen E.} and Sarah Meredith and Palmer, {Kelvin R.} and Logan, {Richard F. A.} and Travis, {Simon P. L.} and Walsh, {Timothy S.} and Murphy, {Michael F.}",

year = "2013",

month = jul,

doi = "10.1016/j.tmrv.2013.04.001",

language = "English",

volume = "27",

pages = "146--153",

journal = "Transfusion medicine reviews",

issn = "0887-7963",

publisher = "W.B. Saunders Company",

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Jairath, V, Kahan, BC, Gray, A, Dore, CJ, Mora, A, Dyer, C, Stokes, EA, Llewelyn, C, Bailey, AA, Dallal, H, Everett, SM, James, MW, Stanley, AJ, Church, N, Darvvent, M, Greenaway, J, Le Jeune, I, Reckless, I, Campbell, HE, Meredith, S, Palmer, KR, Logan, RFA, Travis, SPL, Walsh, TS & Murphy, MF 2013, 'Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial', Transfusion medicine reviews, vol. 27, no. 3, pp. 146-153. https://doi.org/10.1016/j.tmrv.2013.04.001

TY - JOUR

T1 - Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

AU - Jairath, Vipul

AU - Kahan, Brennan C.

AU - Gray, Alasdair

AU - Dore, Caroline J.

AU - Mora, Ana

AU - Dyer, Claire

AU - Stokes, Elizabeth A.

AU - Llewelyn, Charlotte

AU - Bailey, Adam A.

AU - Dallal, Helen

AU - Everett, Simon M.

AU - James, Martin W.

AU - Stanley, Adrian J.

AU - Church, Nicholas

AU - Darvvent, Melanie

AU - Greenaway, John

AU - Le Jeune, Ivan

AU - Reckless, Ian

AU - Campbell, Helen E.

AU - Meredith, Sarah

AU - Palmer, Kelvin R.

AU - Logan, Richard F. A.

AU - Travis, Simon P. L.

AU - Walsh, Timothy S.

AU - Murphy, Michael F.

PY - 2013/7

Y1 - 2013/7

N2 - Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is

AB - Acute upper gastrointestinal bleeding (AUGIB) is the commonest reason for hospitalization with hemorrhage in the UK and the leading indication for transfusion of red blood cells (RBCs). Observational studies suggest an association between more liberal RBC transfusion and adverse patient outcomes, and a recent randomised trial reported increased further bleeding and mortality with a liberal transfusion policy. TRIGGER (Transfusion in Gastrointestinal Bleeding) is a pragmatic, cluster randomized trial which aims to evaluate the feasibility and safety of implementing a restrictive versus liberal RBC transfusion policy in adult patients admitted with AUGIB. The trial will take place in 6 UK hospitals, and each centre will be randomly allocated to a transfusion policy. Clinicians throughout each hospital will manage all eligible patients according to the transfusion policy for the 6-month trial recruitment period. In the restrictive centers, patients become eligible for RBC transfusion when their hemoglobin is

KW - CRITICALLY-ILL PATIENTS

KW - RED-CELL TRANSFUSION

KW - HEALTH RESEARCH

KW - CLINICAL-OUTCOMES

KW - CARDIAC-SURGERY

KW - HEMORRHAGE

KW - REQUIREMENTS

KW - MANAGEMENT

KW - THRESHOLD

KW - MORTALITY

U2 - 10.1016/j.tmrv.2013.04.001

DO - 10.1016/j.tmrv.2013.04.001

M3 - Literature review

SN - 0887-7963

VL - 27

SP - 146

EP - 153

JO - Transfusion medicine reviews

JF - Transfusion medicine reviews

IS - 3

ER -

Restrictive vs Liberal Blood Transfusion for Acute Upper Gastrointestinal Bleeding: Rationale and Protocol for a Cluster Randomized Feasibility Trial

Abstract

Keywords / Materials (for Non-textual outputs)

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