Sunil V. Rao talks with
ScienceWatch.com and answers a few questions about
this month's Fast Moving Fronts paper in the field of Clinical
Article: Relationship of blood transfusion and clinical
outcomes in patients with acute coronary
Authors: Rao SV, Jollis JG, Harrington RA,
Granger CB, Newby LK, Armstrong PW, Moliterno DJ, Lindblad L,
Pieper K, Topol EJ, Stamler JS, Califf RM
Journal: JAMA, Volume: 292, Issue: 13, Pages: 1555-1562,
Published: OCT 6 2004
Addresses: Duke Clin Res Inst, Durham, NC 27715 USA.
Duke Univ, Med Ctr, Howard Hughes Med Inst, Durham, NC 27710
Duke Univ, Med Ctr, Dept Med, Durham, NC 27710
(addresses have been truncated.)
Why do you think your paper is highly
I think it is for two reasons:
1) The therapies we use now for ischemic heart disease work to reduce the
risk of recurrent events but place patients at risk for bleeding
complications, which are often treated with a blood transfusion. We really
don't know how safe transfusion is in this setting because it's never been
2) There is a lot of research going on now that is looking at whether we
can achieve both an efficacious and safe (i.e., reduced bleeding risk)
therapy for patients with heart attack. The studies are testing whether we
can actually improve survival by reducing both the risk of recurrent heart
attack and the risk of bleeding.
Does it describe a new discovery, methodology, or
synthesis of knowledge?
"Hopefully science will always trump politics, but I am
hopeful our research and the research of others who are
working in the field will help to make our blood supply
What it describes is that, for the first time in patients with heart
disease, blood transfusion may not be a benign treatment. Previously, blood
transfusion was looked at as an "insurance policy" against the risks of our
traditional treatments which place patients at risk for bleeding.
Would you summarize the significance of your paper
in layman's terms?
Well, I think it's important to not overinterpret our results. Our study
was not a randomized trial comparing transfusion vs. no transfusion, which
would be the gold standard. However, our study does, for the first time,
warn clinicians to make sure that they think twice before reflexively
giving patients blood transfusions. They really need to think about whether
the patient really needs one.
There are guidelines available to help physicians make these decisions and
they recommend that patients who have symptoms related to anemia (low blood
counts) like chest pain, shortness of breath and dizziness, undergo
transfusion. Other patients who are anemic but have no symptoms should not.
Our study suggests that these latter patients may actually have a higher
risk of death if they receive a transfusion, i.e., no benefit but only
How did you become involved in this research and
were any particular problems encountered along the way?
I got interested in this quite by accident. I was working on another
completely unrelated study that involved looking at billing records and we
found that among community-dwelling otherwise healthy people over the age
of 65, the most common procedure that was being performed was blood
This really amazed me and when I looked into it, I realized that there was
really no good evidence that supported the use of blood transfusion. The
biggest problem we encountered was skepticism in the clinical community
regarding our findings. This is healthy though, because it does demand that
we generate higher levels of evidence. Our study is just the first step.
Where do you see your research leading in the
We're hoping to start a randomized trial in the near future to see if our
findings from the observational study hold up when tested prospectively.
Do you foresee any social or political
implications for your research?
Hopefully science will always trump politics, but I am hopeful our research
and the research of others who are working in the field will help to make
our blood supply even safer.
Sunil V. Rao MD, FACC FSCAI
Assistant Professor of Medicine
Duke University Medical Center
Director, Cardiac Catheterization Laboratories
Durham VA Medical Center
Durham, NC, USA