UPPER GASTROINTESTINAL BLEEDING: A COMPARATIVE STUDY BETWEEN LIBERAL AND RESTRICTIVE TRANSFUSION STRATEGIES

Background: Upper gastrointestinal bleeding is a prevalent condition with a mortality rate that is as high as 15%. The optimal red blood cell transfusion strategy in acute gastrointestinal bleeding is debated. Aim of study: This study aims to compare between patients with upper GI bleeding receiving restrictive and liberal transfusion strategies regarding in hospital management, complications, overall survival, and adverse outcomes. Patients and methods: This is an analytic prospective cohort study that included 227 patients and was conducted in Baghdad Teaching Hospital/ Medical city, Baghdad. The data was collected from the 1st of January 2023 to the 1st of January 2024. All adult patients (>18 years) diagnosed with presenting with upper gastrointestinal bleeding to the emergency department during the study period were included in the study. At admission, patients were assigned to undergo either liberal transfusion protocol or restrictive protocol. In the restrictive-strategy group, the hemoglobin threshold for transfusion was 7 g per deciliter. In the liberal-strategy group, the hemoglobin threshold for transfusion was 9 g per deciliter. The primary outcome measure was the rate of death in the emergency department. Secondary outcomes included the rate of further bleeding and the rate of in-hospital complications. Results: Patients of the liberal group were significantly more likely to need variceal banding (P=0.002) and octreotide injection (P=0.008). Overall emergency department mortality was seen in 3 (2.7%) cases of the restrictive group and 12 (10.4%) cases of the liberal group, with the difference being statistically significant (P value = 0.030). A statistically significant difference was detected between both study groups regarding the incidence of transfusion-associated circulatory overload and pulmonary edema. Conclusion: According to the results of the current study, patients who underwent transfusion with a restrictive strategy exhibited a notable decrease in the requirement for banding and octreotide therapy. Additionally, there was an enhancement in the overall survival and a decrease in transfusion-related complications.