RCT

SAHARA

Liberal or Restrictive Transfusion Strategy in Aneurysmal Subarachnoid Hemorrhage

NEJM, 2025 · Randomized multicenter trial

Clinical question

Does a liberal RBC transfusion threshold improve neurologic outcome in aneurysmal subarachnoid hemorrhage with anemia?

Population: Adults with aneurysmal subarachnoid hemorrhage and anemia
Intervention: Liberal transfusion threshold approximately Hb <=10 g/dL
Comparator: Restrictive threshold approximately Hb <=8 g/dL
Primary outcome: Unfavorable neurologic outcome at 12 months
Result: The liberal strategy did not significantly reduce unfavorable neurologic outcome at 12 months (33.5% vs 37.7%; P=0.22).

What the trial found

Routine liberal transfusion did not significantly improve long-term neurologic outcome.

Current guideline position

Contemporary neurocritical-care evidence.

Clinical interpretation

Use individualized transfusion decisions in aSAH rather than assuming higher hemoglobin improves neurologic recovery.

Clinical Context & Relevant Topics (2)

Disease Reference

Blood Product Transfusion in Critical Care

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

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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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