Liberal Blood Transfusion Strategy May Improve Outcomes in Heart Attack Patients with Anaemia

Liberal Blood Transfusion Strategy May Improve Outcomes in Heart Attack Patients with Anaemia

A recent analysis of the Myocardial Ischemia and Transfusion (MINT) randomized clinical trial suggests that maintaining higher haemoglobin levels through a liberal red blood cell transfusion strategy may reduce the risk of death or recurrent myocardial infarction in patients with myocardial infarction (MI) and anaemia. The post hoc Bayesian analysis included 3,504 adults admitted with MI across 144 hospitals in six countries. Participants were assigned to either a restrictive transfusion strategy, in which transfusions were recommended when haemoglobin levels fell below 7–8 g/dL, or a liberal strategy that aimed to maintain haemoglobin levels above 10 g/dL. Across multiple statistical models, the liberal approach consistently demonstrated a high probability of lowering the combined risk of death or recurrent heart attack within 30 days, indicating that maintaining adequate oxygen-carrying capacity may offer additional protection during the recovery period following MI.

While the liberal transfusion strategy was linked to a small increase in the likelihood of heart failure, researchers found that its overall clinical benefits outweighed this potential risk. The analysis estimated that treating approximately 200 eligible patients with the liberal strategy could prevent around five cases of death or recurrent myocardial infarction while resulting in only one additional heart failure event. These findings are in line with current clinical guidance supporting individualized transfusion decisions based on the patient's cardiovascular status, symptoms, and overall risk profile rather than haemoglobin concentration alone. The authors emphasize that transfusion strategies should be tailored through shared decision-making, combining the best available evidence with clinical judgement and patient preferences to achieve optimal outcomes.

Reference

Bertolet M, et al. Restrictive vs Liberal Transfusion Strategy After Myocardial Infarction: A Post Hoc Analysis of the MINT Randomized Clinical Trial. JAMA Network Open. 2026;9(7).