Blood Transfusion Benefits Heart Attack and Anemia Patients

An international clinical trial led by physician Jeffrey L. Carson, distinguished professor of medicine at Rutgers Robert Wood Johnson Medical School, discovered that a generous blood transfusion given to patients who have had a heart attack and have anemia may reduce the risk of reoccurrence and improve survival rates. The findings of the Myocardium Infarction and Transfusion (MINT) experiment were published today in the New England Journal of Medicine. The report was co-authored by Maria Mori Brooks, professor of epidemiology and biostatistics at the University of Pittsburgh School of Public Health.

“Transfusion threshold trials are important to help physicians inform decisions that provide the most benefit for their patients,” Carson went on to say. The goal of the MINT trial was to establish evidence that can be used to set transfusion standards for patients who have had a heart attack, to improve their rate of survival and reduce the risk of additional heart attacks.

The MINT trial included almost 3,500 patients from 144 hospitals in six countries. Half of the individuals in the trial were given extra blood to keep their blood count over 10 grams per deciliter (g/dL), which is considered a liberal transfusion technique. The stringent transfusion technique meant that half of the people didn’t get blood unless their blood count was less than eight g/dL. All participants in the study experienced a heart attack and anemia (a hemoglobin blood level of less than 10 g/dL). A normal blood count is 12 to 13 g/dL.

“The results of the MINT trial indicate that a liberal strategy of blood transfusion may improve outcomes in anemic patients with heart attacks without causing undue harm,” Dr. Carson said.

The findings of the multicenter randomized clinical study, which was financed by the National Institutes of Health National Heart, Lung, and Blood Institute (NHLBI), were presented during the Late-Breaking Scientific Sessions of the 2023 American Heart Association annual conference.

A significant number of patients had previously experienced a heart attack, heart failure, diabetes, or kidney illness. The average age of the participants was 72, with women accounting for 45 percent of the total.

Although the blood transfusion approach was allocated at random, health professionals caring for patients in hospitals had clinical discretion to follow the study to assure quality of care for their patients.

The researchers compared the frequency of the primary outcome of death or recurrent heart attack 30 days after enrolling in the experiment. Although not statistically significant, the study indicated that when a liberal strategy was utilized, the likelihood of mortality or recurrent heart attack was 2.4% lower.

Brooks, the primary investigator of the MINT trial’s data coordinating center, stated that with 3,500 patients, MINT delivers the greatest data available to answer an important question that clinicians encounter every day.

“The trial results suggest that the liberal strategy may be superior, but they also suggest that the two approaches may be similar.” “These findings push us to dig deeper,” Brooks added. “Do some patients benefit more than others?” And why? Our next step will be to answer those queries.”

Carson has spent over two decades researching the effects of red blood cell transfusion techniques on patient care. His work helped produce transfusion recommendations in 2012, which are used by clinicians to inform patient care. Updates to these guidelines were presented last month in the Journal of the American Medical Association, emphasizing a customized approach in adults and children that accounts for comorbid diseases.

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