LandmarkRCT

TRAIN

Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial

JAMA, 2024 · Open-label multicenter randomized trial with blinded outcome assessment

Population: 850 randomized adults with TBI, ICH or aSAH and anemia
Intervention: Transfusion trigger Hb <9 g/dL
Comparator: Hb <7 g/dL
Primary outcome: Unfavorable GOSE at 180 days
Result: 62.6% versus 72.6%; adjusted RR 0.86 (95% CI 0.79–0.94).

What the trial found

Liberal strategy improved the primary neurologic outcome in the mixed-injury cohort.

Clinical interpretation

Do not equate thresholds, injury populations or outcome definitions with HEMOTION/SAHARA; individualize application.

Moderate certainty

Clinical Context & Relevant Topics (2)

Disease Reference

Intracranial Hemorrhage: ICH & SAH

Spontaneous ICH vs Aneurysmal SAH, INTERACT-2/ATACH-2 blood pressure targets, emergency anticoagulant reversal, ENRICH minimally invasive evacuation, ISAT coiling, and Nimodipine for delayed cerebral ischemia.

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Severe Traumatic Brain Injury

Severe TBI neurocritical care: prevent hypoxemia/hypotension, treat intracranial hypertension, individualize ventilation/CPP, use evidence-based short antiseizure prophylaxis when chosen, and escalate surgery when indicated.

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