Methodology: 4/5
Usefulness: 3.5/5

Carson JL, et al. N Engl J Med. 2023 Dec 28;389(26):2446-2456. doi: 10.1056/NEJMoa2307983. 

Questions and methods: This multicenter, open-label, RCT of 3604 patients with MI with anemia compared 30-day all-cause mortality and recurrent nonfatal MI between liberal vs restrictive transfusion thresholds.
Findings: There was no significant difference in 30-day all-cause mortality and recurrent nonfatal MI between the restrictive (16.9%) and liberal (14.5%) transfusion thresholds (RR1.15, 95%CI0.99-1.34, p=0.07).
Limitations: Limitations include lack of blinding to healthcare professionals, use of composite outcomes, and lack of full adherence to liberal transfusion strategy.

Interpretations: In patients with type 1 MI and anemia and at low risk for transfusion-related adverse outcomes, a liberal transfusion strategy should be considered.

By: Dr. Suzanne Boroumand

JC Supervisor: Dr. Venkatesh Thiruganasambandamoorthy




  • Suzanne Boroumand

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  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

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  • Venkatesh Thiruganasambandamoorthy

    Dr. Venkatesh Thiruganasambandamoorthy is an attending physician and associate scientist at the Ottawa Hospital and Ottawa Hospital Research Institute with an particular interest in syncope and presyncope care.

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