Impact of Red Pack Cell Transfusion Before or After Endoscopy on Mortality in Patients with Upper Gastrointestinal Bleeding: A Multicenter Cohort Study

Background: The impact of transfusion timing relative to endoscopy in upper gastrointestinal bleeding (UGIB) remains unclear. Aim: To assess whether transfusion performed before versus after endoscopy affects 30-day mortality in UGIB. Methods: We conducted a post hoc analysis of a multicenter cohort study including 3324 UGIB patients consecutively admitted in hospital. Propensity score matching adjusted for clinical and procedural variables. Results: Among 2017 transfused patients, 34.7% received Red Blood Cells (RBC) before endoscopy. Patients who received transfusions before endoscopy were older, had more severe comorbidities, and presented with a worse physical and hemodynamic status. This study also explored whether transfusion timing relative to endoscopy affects clinical outcomes in patients stratified by baseline hemoglobin levels. While pre-endoscopy transfusion was not significantly associated with reduced 30-day mortality in the overall population, we observed an advantage in patients transfused before the endoscopy when the Hb value was <7 g/dL. Pre-endoscopy transfusion was associated with a 6% absolute reduction in 30-day mortality (p < 0.06), with a greater benefit observed in patients with Hb < 7 g/dL (−27%) and <8 g/dL (−21%). Moreover, for this group of patients more favorable outcome was observed when the endoscopy was performed between 6 and 12 h from admission. These findings suggest that transfusion timing should be integrated into individualized UGIB management and may impact future clinical guidelines. Conclusions: In patients with severe anemia and UGIB, transfusion before endoscopy may reduce mortality. Timing to transfusion should be considered alongside hemodynamic and procedural factors in future guidelines.