Restrictive vs Liberal Transfusion Strategy in Traumatic Brain Injury: A Secondary Analysis of the TRAIN Trial - Summary - MDSpire
Coming Soon: Introducing MDSpire News. Learn more
Conexiant’s news site is now MDSpire News. Learn more

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

Share

Objective:

To examine how varying hemoglobin thresholds for red blood cell transfusion affect neurological outcomes in patients with traumatic brain injury (TBI).

Approach:
  • Study Design: Secondary analysis of the TRAIN trial, a multicenter, phase 3, pragmatic, open-label randomized clinical trial.
  • Participants: Adults aged 18 years or older with acute brain injury and hemoglobin levels of 9 g/dL or less.
  • Transfusion Strategies: Participants were assigned to either a restrictive strategy (RBCT at Hb <7 g/dL) or a liberal strategy (RBCT at Hb <9 g/dL).
  • Outcome Measures: Primary outcome was unfavorable neurological outcome assessed by the Glasgow Outcome Scale Extended (GOS-E) at 180 days.
Key Findings:
  • The liberal transfusion strategy was associated with a lower occurrence of unfavorable neurological outcomes compared to the restrictive strategy.
Interpretation:

The findings suggest that a liberal transfusion strategy may be beneficial in improving neurological outcomes in patients with TBI, potentially leading to better recovery trajectories. This contrasts with the restrictive approach, which may not provide adequate support for patients with significant brain injuries.

Limitations:
  • The results are based on a secondary analysis and may not be specific to TBI as the parent study included various acute brain injuries.
  • No separate sample size calculation was performed for the TBI subgroup.
Conclusion:

In patients with TBI, adopting a liberal blood transfusion strategy may lead to improved neurological outcomes compared to a restrictive strategy, highlighting the need for careful consideration of transfusion thresholds in clinical practice. Further studies are warranted to validate these findings and refine transfusion protocols for this patient population.

Sources:

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

Related Content

Heat stroke presenting with choreiform dyskinesias: an unusual MRI pattern

Neurology Wait Times in the Cognitive Care Journey

PET/MRI may reveal MRI-occult inflammation

In a rare anti-vimentin encephalitis case, molecular imaging detected abnormalities that declined alongside neurologic improvement following immunotherapy.