Five 'Quick Hits' in Hospital Medicine

William J. Collins, MD

Disclosures

June 18, 2019

In This Article

Curtains Down for Aspirin in Primary Prevention

A new meta-analysis that included data from three recent large trials (ASPREE, ASCEND, ARRIVE)[6] showed that the number needed to treat for aspirin to prevent one cardiovascular event was 265, whereas the number needed to harm for one major bleeding event was 210. This supports recent recommendations to consider taking patients off aspirin for primary prevention and focus on other prevention strategies, such as statins.

(Maybe) More Support for Restrictive Transfusion

An interesting retrospective cohort study examining a large data set (445,371 patients) from Kaiser Northern California looked at rates of moderate anemia (hemoglobin level 7-10g/dL) at discharge and red blood cell (RBC) transfusions among hospitalized adults from 2010 to 2014.[7] This period coincided with recommendations to lower the hemoglobin threshold for RBC transfusion.[8]

Indeed, the overall number of RBC transfusions and the proportion of patients transfused both fell year over year during the study period. This coincided with an increased number of patients with moderate anemia at the time of discharge and 6 months later, but not with increased rates of rehospitalization or 6-month mortality rates, both of which actually declined.

These data are observational and don't establish causality. We can't conclude that fewer transfusions in patients with moderate anemia would improve mortality rates. But it is at least reassuring that rehospitalization and mortality rates did not rise in the setting of more restrictive transfusion.

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