Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage

The SAHARA trial investigated the effect of liberal versus restrictive red-cell transfusion strategies in critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia. Patients were randomized to a liberal strategy (mandatory transfusion at hemoglobin $\le 10$ g/dL) or a restrictive strategy (optional transfusion at hemoglobin $\le 8$ g/dL). The primary outcome, an unfavorable neurologic outcome at 12 months (modified Rankin scale score $\ge 4$), occurred in 33.5% of the liberal-strategy group and 37.7% of the restrictive-strategy group (risk ratio, 0.88; 95% CI, 0.72 to 1.09; $P=0.22$). Secondary outcomes, including functional independence and quality of life, did not show significant differences between the groups. The incidence of adverse events was similar. The study concluded that a liberal transfusion strategy did not result in a lower risk of unfavorable neurologic outcomes at 12 months compared to a restrictive strategy in this patient population. 

The SAHARA trial investigated the effect of liberal versus restrictive red-cell transfusion strategies in critically ill adults with acute aneurysmal subarachnoid hemorrhage and anemia. Patients were randomized to a liberal strategy (mandatory transfusion at hemoglobin $\le 10$ g/dL) or a restrictive strategy (optional transfusion at hemoglobin $\le 8$ g/dL). The primary outcome, an unfavorable neurologic outcome at 12 months (modified Rankin scale score $\ge 4$), occurred in 33.5% of the liberal-strategy group and 37.7% of the restrictive-strategy group (risk ratio, 0.88; 95% CI, 0.72 to 1.09; $P=0.22$). Secondary outcomes, including functional independence and quality of life, did not show significant differences between the groups. The incidence of adverse events was similar. The study concluded that a liberal transfusion strategy did not result in a lower risk of unfavorable neurologic outcomes at 12 months compared to a restrictive strategy in this patient population.