Neuroanesthesia & neurocritical care
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial
An erratum to this article was published (JAMA, 11 Mar 2025 ↗)
Authors' conclusion
Patients with acute brain injury and anemia randomized to a liberal transfusion strategy were less likely to have an unfavorable neurological outcome than those randomized to a restrictive strategy.
Study context
- Population
- ICU patients with TBI, aneurysmal SAH or intracerebral hemorrhage, hemoglobin <9 g/dL within 10 days after injury, expected ICU stay ≥72 hours; 72 ICUs, 22 countries820 completed
- Participants
- 850 patients
- Comparison
- Liberal vs restrictive RBC transfusion strategy over 28 days
- Liberaln = 408
- Restrictiven = 442reference
- Primary endpoint
- Unfavorable neurological outcome (Glasgow Outcome Scale Extended score 1–5)
- Follow-up
- 180 days
Methodological detailsmulticentre, phase 3, parallel-group, investigator-initiated, pragmatic, open-label, 72 ICUs in 22 countries; enrollment September 1, 2017 to December 31, 2022; last follow-up June 30, 2023
- Multicentre
- Phase 3
- Parallel-group
- Investigator-initiated
- Pragmatic
- Open-label
- 72 ICUs in 22 countries; enrollment September 1, 2017 to December 31, 2022; last follow-up June 30, 2023
Primary result
As reported in the abstract
Each group vs restrictiveAbsolute difference (95% CI)
Liberal
−10.0%(−16.5% to −3.6%)
Each group vs restrictiveAdjusted relative risk (95% CI)P value
Liberal
0.86(0.79–0.94)
P = 0.002Further findings
| Outcome | Liberal | Restrictive | Absolute mean difference (unit) (95% CI) | |
|---|---|---|---|---|
| RBC units received | median 2 (IQR 1–3) units | median 0 (IQR 0–1) units | 1.0 (0.87–1.12) | |
| −0.500.511.5Difference, unit (linear scale) |
Unfavorable neurological outcome, prespecified subgroups (subgroup) · 180 days
- Effect consistent across prespecified subgroups
Safety
| Outcome | Liberal | Restrictive | RR (95% CI) | |
|---|---|---|---|---|
| ≥1 cerebral ischemic event | 8.8% · 35 of 397 | 13.5% · 57 of 423 | 0.65 (0.44–0.97) | |
| 0.512Relative risk (log scale) |
Original publication
Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. JAMA. Published 19 November 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →