Blood Transfusion Indications in Acute Myocardial Infarction and Anemia: A Comprehensive Review of Current Evidence and Clinical Implications

Background: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality worldwide. Anemia, commonly encountered in patients with AMI, is associated with worsened outcomes due to impaired oxygen delivery to ischemic myocardium. Blood transfusion is often considered in this clinical scenario, yet its indications remain controversial due to potential risks such as volume overload, inflammatory reactions, and prothrombotic effects. Objective: This review aims to explore the current evidence surrounding blood transfusion in AMI patients with anemia, focusing on the clinical thresholds, patient selection, and the balance between benefits and risks. Methods: A thorough literature search of randomized controlled trials, observational studies, and current guidelines was conducted to assess the impact of transfusion strategies in AMI patients with concurrent anemia. Results: Evidence suggests a restrictive transfusion strategy, targeting hemoglobin thresholds between 7–8 g/dL, may be non-inferior to liberal strategies for most stable AMI patients. However, individualized decision-making is critical, particularly in patients with hemodynamic instability, ongoing ischemia, or comorbidities such as chronic kidney disease. Conclusions: The management of anemia in AMI is multifaceted and requires a careful assessment of risks and benefits. Future research should address the heterogeneity of patient populations to refine transfusion protocols.