Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial - Report - MDSpire
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Comparative Analysis of Restrictive and Liberal Blood Transfusion Approaches in Patients with Traumatic Brain Injury: Insights from the TRAIN Trial

  • By

  • Irene Sbaraini Zernini

  • Chiara Faso

  • Carla Bittencourt Rynkowski

  • Kirsten Moller

  • Piet Lormans

  • Manuel Quintana Diaz

  • Anselmo Caricato

  • Marjorie Beumier

  • Evy Voets

  • Mario Arias

  • Herve Quintard

  • Diego Morocho

  • Pedro Kurtz

  • Erik Roman Pognuz

  • Olivier Huet

  • Ata Mahmoodpoor

  • Aaron Blandino-Ortiz

  • Sara Alcantara

  • Russell Chabanne

  • Francisco Cicho

  • Stan Popugaev

  • Angelo Giacomucci

  • Jamil Dibu

  • Raphael Cinotti

  • Pierre Bouzat

  • Jean-Louis Vincent

  • Elisa Gouvêa Bogossian

  • Fabio Silvio Taccone

  • TRAIN Study Trial Group

  • Claudia Díaz

  • Andrés Saravia

  • Ahmas Bayrlee

  • Laura Nedolast

  • Hussam Elkambergy

  • Haamid Siddique

  • Jihad Mallat

  • Nahla AlJaberi

  • Samer Shoshan

  • Ayo Mandi

  • Bruno De Oliveira

  • Malligere Prasanna

  • Rehan Haque

  • Dnyaneshwar Munde

  • Sara Chaffee

  • Fatma Alawadhi

  • Eija Junttila

  • Teemu Luoto

  • Simona Šteblaj

  • Jacques Creteur

  • Dominique Durand

  • Caroline Abbenhuijs

  • Nancy Itesa Matumikina

  • Filippo Annoni

  • Leda Nobile

  • Miguel Ulloa Bersatti

  • Igor Yovenko

  • Alexander Tsarev

  • Jasperina Dubois

  • Luc Janssen

  • Luigi Zattera

  • Leire Pedrosa

  • Berta Monleon Lopez

  • Ainhoa Serrano

  • Nekane Romero-García

  • Xavier Wittebole

  • Antonio M Dell'Anna

  • Camilla Gelormini

  • Eleonora Stival

  • Pilar Marcos Neira

  • Regina Roig Pineda

  • Lara Bielsa Berrocal

  • Maite Misis del Campo

  • Stepani Bendel

  • Jorge H Mejía-Mantilla

  • Ángela Marulanda

  • Wojciech Dabrowski

  • Rune Damgaard Nielsen

  • Markus Harboe Olsen

  • Helene Ravnholt Jensen

  • Ida Møller Larsen

  • Roberta Tallarico

  • Umberto Lucangelo

  • Maria Isabel Gonzales Perez

  • Carole Ichai

  • Karim Asenhoune

  • Karim Lakhal

  • Charlotte Fernandez-Canal

  • Samuel Gay

  • Marie Lebouc

  • David Bougon

  • Etienne Escudier

  • Michel Sirodot

  • Albrice Levrat

  • Alix Courouau

  • Jacques Duranteau

  • Aurore Rodrigues

  • Naima Makouche

  • Gilles Francony

  • Olivier Vincent

  • Perrine Boucheix

  • Clotilde Schilte

  • Anais Adolle

  • Thomas Gargadennec

  • Patricia Dias

  • Gwenaelle Desanglois

  • Alexia Meheut

  • Pauline Cam

  • Geert Meyfroidt

  • Liese Mebis

  • Alexandra Hendrickx

  • Pieetr Wouters

  • Sylvia Van Hulle

  • Alain D'Hondt

  • Marc Burgeois

  • Olivier Simonet

  • Frederic Vallot

  • Pablo Centeno

  • Matias Anchorena

  • Ximena Benavente

  • Maximilian D'Onofrio

  • Nydia Funes

  • Antonio Barra de Oca

  • Gabriela Izzo

  • Charlotte Castelain

  • Filippo Soetens

  • Manuel Jabaja

  • Diego Tutillo

  • Celeste Dias

  • Elena Perez Solada

  • Pilar Justo

  • Amparo Lopez Gomez

  • Francisco Chico

  • Maria Fernanda Garcia

  • Fabricio Picoita

  • Stela Velasco Eichler

  • Gabriela Nonticuri Bianchi

  • João Pedro Britz

  • Jaqueline Almeida Pimentel

  • Mário Sérgio Fernandes

  • Hedi Gharsallah

  • Zied Hajjej

  • Walid Samoud

  • Oleg Grebenchikov

  • Valery Likhvantsev

  • Elena Stroiteleva

  • Nikolaos Markou

  • Dimitra Bakali

  • Dionysia Koutrafouri

  • Ahmed Subhy Alsheikhly

  • Sara Maccherani

  • Janneke Horn

  • Mohamed Elbahnasawy

  • Arezoo Ahmadi

  • Lien Decaesteker

  • Daphne Decruyenaere

  • Ruth Demeersseman

  • Yves Devriendt

  • Karen Embo

  • Ditty van Duijn

  • Patricia Ormskerk

  • Melanie Glasbergen-van Beijeren

  • Hassane Njimi

  • Alain Cariou

  • Christophe Lelubre

  • Giuseppe Ristagno

  • Nino Stocchetti

  • Mauro Oddo

  • Cathy De Deyne

  • Giuseppe Citerio

  • September 8, 2026

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Clinical Report: Comparative Analysis of Blood Transfusion Approaches in TBI

Background

Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide, with significant economic implications. Anemia is prevalent among TBI patients, often complicating their management in the intensive care unit (ICU). Approximately 50% of TBI patients present with anemia, commonly defined as a hemoglobin (Hb) concentration below 9 g/dL. Understanding optimal transfusion strategies is crucial, as both anemia and transfusion practices can significantly influence patient outcomes.

Data Highlights

No numerical data provided in the source material. Key findings include the prevalence of anemia in TBI patients and the outcomes of the TRAIN and HEMOTION trials regarding transfusion strategies.

Key Findings

  • Approximately 50% of TBI patients present with anemia, defined as Hb <9 g/dL.
  • The TRAIN trial indicated that a liberal transfusion strategy (Hb <9 g/dL) significantly lowered the risk of unfavorable neurological outcomes compared to a restrictive strategy (Hb <7 g/dL).
  • Neurological outcomes did not differ significantly between liberal (Hb <10 g/dL) and restrictive (Hb <7 g/dL) strategies in the HEMOTION trial.
  • Risks associated with red blood cell transfusion include transfusion-related acute lung injury and transfusion-associated cardiac overload.
  • Optimal transfusion management for TBI remains an area of ongoing research and debate.

Clinical Implications

Clinicians should consider the potential benefits of a liberal transfusion strategy in TBI patients with anemia, particularly in terms of neurological outcomes. Ongoing monitoring and individualized patient assessment remain essential in transfusion decision-making.

Conclusion

The findings from the TRAIN trial's secondary analysis suggest that a liberal transfusion strategy may be more beneficial for TBI patients compared to a restrictive approach, highlighting the need for further research in this area.

Related Resources & Content

  1. Author(s)/Org, Source, Year -- Title
  2. Author(s)/Org, Source, Year -- Title
  3. American College of Surgeons, Best Practices Guidelines, 2023 -- Management of Traumatic Brain Injury
  4. Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury: a sub-study of the HEMOTION trial
  5. Critical Care (Springer) — Correspondence on the Study of Transfusion Strategies in Veno-Arterial Extracorporeal Membrane Oxygenation Patients: Insights from the OBLEX Data Analysis
  6. JAMA Surgery — Error in Key Points
  7. Frontiers in Neurology — Development of an automated machine learning-based prediction model and interactive tool for blood transfusion requirements in patients with severe traumatic brain injury
  8. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury
  9. Influence of multiple trauma on the effect of transfusion strategies in patients with traumatic brain injury
  10. https://www.facs.org/media/vgfgjpfk/best-practices-guidelines-traumatic-brain-injury.pdf
  11. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial | Trials | JAMA | JAMA Network
  12. Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial | Critical Care Medicine | JAMA Network Open | JAMA Network

Original Source(s)

Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial

  • by Irene Sbaraini Zernini, Chiara Faso, Carla Bittencourt Rynkowski, Kirsten Moller, Piet Lormans, Manuel Quintana Diaz, Anselmo Caricato, Marjorie Beumier, Evy Voets, Mario Arias, Herve Quintard, Diego Morocho, Pedro Kurtz, Erik Roman Pognuz, Olivier Huet, Ata Mahmoodpoor, Aaron Blandino-Ortiz, Sara Alcantara, Russell Chabanne, Francisco Cicho, Stan Popugaev, Angelo Giacomucci, Jamil Dibu, Raphael Cinotti, Pierre Bouzat, Jean-Louis Vincent, Elisa Gouvêa Bogossian, Fabio Silvio Taccone, TRAIN Study Trial Group, Claudia Díaz, Andrés Saravia, Ahmas Bayrlee, Laura Nedolast, Hussam Elkambergy, Haamid Siddique, Jihad Mallat, Nahla AlJaberi, Samer Shoshan, Ayo Mandi, Bruno De Oliveira, Malligere Prasanna, Rehan Haque, Dnyaneshwar Munde, Sara Chaffee, Fatma Alawadhi, Eija Junttila, Teemu Luoto, Simona Šteblaj, Jacques Creteur, Dominique Durand, Caroline Abbenhuijs, Nancy Itesa Matumikina, Filippo Annoni, Leda Nobile, Miguel Ulloa Bersatti, Igor Yovenko, Alexander Tsarev, Jasperina Dubois, Luc Janssen, Luigi Zattera, Leire Pedrosa, Berta Monleon Lopez, Ainhoa Serrano, Nekane Romero-García, Xavier Wittebole, Antonio M Dell'Anna, Camilla Gelormini, Eleonora Stival, Pilar Marcos Neira, Regina Roig Pineda, Lara Bielsa Berrocal, Maite Misis del Campo, Stepani Bendel, Jorge H Mejía-Mantilla, Ángela Marulanda, Wojciech Dabrowski, Rune Damgaard Nielsen, Markus Harboe Olsen, Helene Ravnholt Jensen, Ida Møller Larsen, Roberta Tallarico, Umberto Lucangelo, Maria Isabel Gonzales Perez, Carole Ichai, Karim Asenhoune, Karim Lakhal, Charlotte Fernandez-Canal, Samuel Gay, Marie Lebouc, David Bougon, Etienne Escudier, Michel Sirodot, Albrice Levrat, Alix Courouau, Jacques Duranteau, Aurore Rodrigues, Naima Makouche, Gilles Francony, Olivier Vincent, Perrine Boucheix, Clotilde Schilte, Anais Adolle, Thomas Gargadennec, Patricia Dias, Gwenaelle Desanglois, Alexia Meheut, Pauline Cam, Geert Meyfroidt, Liese Mebis, Alexandra Hendrickx, Pieetr Wouters, Sylvia Van Hulle, Alain D'Hondt, Marc Burgeois, Olivier Simonet, Frederic Vallot, Pablo Centeno, Matias Anchorena, Ximena Benavente, Maximilian D'Onofrio, Nydia Funes, Antonio Barra de Oca, Gabriela Izzo, Charlotte Castelain, Filippo Soetens, Manuel Jabaja, Diego Tutillo, Celeste Dias, Elena Perez Solada, Pilar Justo, Amparo Lopez Gomez, Francisco Chico, Maria Fernanda Garcia, Fabricio Picoita, Stela Velasco Eichler, Gabriela Nonticuri Bianchi, João Pedro Britz, Jaqueline Almeida Pimentel, Mário Sérgio Fernandes, Hedi Gharsallah, Zied Hajjej, Walid Samoud, Oleg Grebenchikov, Valery Likhvantsev, Elena Stroiteleva, Nikolaos Markou, Dimitra Bakali, Dionysia Koutrafouri, Ahmed Subhy Alsheikhly, Sara Maccherani, Janneke Horn, Mohamed Elbahnasawy, Arezoo Ahmadi, Lien Decaesteker, Daphne Decruyenaere, Ruth Demeersseman, Yves Devriendt, Karen Embo, Ditty van Duijn, Patricia Ormskerk, Melanie Glasbergen-van Beijeren, Hassane Njimi, Alain Cariou, Christophe Lelubre, Giuseppe Ristagno, Nino Stocchetti, Mauro Oddo, Cathy De Deyne, Giuseppe Citerio

  • September 8, 2026

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