Historical collection · First published Dec 9, 2024; added to EM Weekly Oct 27, 2026. This retrospective summary may be superseded by later evidence or guidance.
← All articlesLiberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage
Summary
SAHARA randomized 742 critically ill adults with aneurysmal SAH and anemia to liberal or restrictive transfusion. Unfavorable 12-month neurologic outcomes occurred in 33.5% versus 37.7% (RR 0.88; 95% CI 0.72–1.09; P=.22). Adverse-event incidence was similar.
Why it matters
Does not establish a benefit from routinely transfusing every anemic SAH patient at 10 g/dL. Coordinate thresholds with neurocritical care rather than extrapolating from other brain-injury populations.
Study at a glance
- Design
- Randomized trial
- Population
- Critically ill adults with acute aneurysmal SAH and anemia at 23 centers.
- Sample size
- 742
- Intervention
- Mandatory red-cell transfusion when hemoglobin was ≤10 g/dL.
- Comparator
- Optional transfusion when hemoglobin was ≤8 g/dL.
- Primary endpoint
- Modified Rankin Scale ≥4 at 12 months.
Main findings
- Primary outcome: 122/364 versus 136/361; 725 participants had outcome data.
- Functional independence and quality-of-life measures did not clearly differ.
Limitations
The confidence interval includes clinically relevant benefit and does not prove equivalence. This critical-care strategy was not a trial of resuscitation for active hemorrhagic shock.
Read the primary source
Full text: Abstract available; full text paywalled.
Original sourcePMID: 39655786
Material reviewed: abstract.
Source retrieved Oct 27, 2026. Historical backfill: first-online date verified from the PubMed electronic publication record. Abstract reviewed; full text unavailable. This is historical evidence, not a new 2026 publication.
Corrections & review history
No corrections recorded. Human review: not yet human-reviewed.