Please select the eligibility criteria that correspond to the clinical trial below.
Title: Myocardial Ischemia and Transfusion Pilot
Brief Summary: The purpose of this study is to evaluate two approaches to red blood cell transfusion in anemic patients with acute coronary syndrome.


Options:
A: Inclusion Criteria:

* Males and females older than 18 years of age who have postoperative Hb \< 10gm/dl within 15 days after the index operation
* Patients who undergo an operation in either one of the three following categories:

  * Veterans who undergo PAD - related operations including but not limited to the following:

    * aortobifemoral or aortobiiliac bypass
    * open abdominal aortic aneurysm repair with simultaneous repair of aortoiliac occlusive disease
    * visceral bypass
    * iliofemoral bypass
    * femoral bypass or endarterectomy
    * infrainguinal bypass
    * thromboembolectomy
    * supra-aortic trunk bypass or endarterectomy
    * carotid endarterectomy
    * major lower extremity amputations (transfemoral, through the knee, or transtibial)
  * Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following general surgery procedures, defined as:

    * known prior MI
    * ECG findings consistent with prior MI
    * prior percutaneous coronary intervention
    * prior coronary artery bypass surgery
    * history of angina for which the patient is currently receiving treatment
    * stress test indicating myocardial ischemia
    * who undergo the following General Surgery operations:

      * Open cholecystectomy or other complex biliary reconstruction
      * such as open common bile duct exploration for stones
      * reconstruction as part of oncologic operations such as palliative pancreatic cancer procedures)
    * small bowel resection
    * pancreatectomy
    * colon resection
    * rectal resection
    * splenectomy
    * transhiatal esophagectomy
    * liver resection
    * gastric resection
    * open ventral hernia repair
    * Colostomies (reversals and takedowns)
    * Intestinal anastomosis takedowns and revisions
    * Gastric bypass
    * Adrenalectomies
    * Major diaphragmatic hiatal hernia repairs
  * Veterans with past medical history of ischemic stroke or IHD or PAD who undergo the following Vascular Surgery operations:

    * Open aneurysm repair, including but not limited to:

      * carotid
      * subclavian
      * abdominal aortic
      * iliac
      * femoral
      * popliteal aneurysms
    * and complex endovascular aneurysm repair, defined as:

      * fenestrated endograft
      * or endograft with need for iliac conduit
      * or endovascular aneurysm repair with simultaneous femoral artery reconstruction or bypass
    * Subclavian/vertebral bypasses and transpositions
* Patients undergoing the above procedures will be included in the study regardless of their preoperative Hb level, and regardless of preoperative or intraoperative transfusion they might have received.

Exclusion Criteria:

* Veteran unable to consent
* Veteran unwilling to follow protocol (such as Jehovah's witnesses)
* Veteran with known history of hereditary anemias such as Thalassemia or Sickle cell disease
* Veteran with known history of hereditary bleeding disorders, such as factor VIII or factor IX deficiency
* Veteran with prior history of adverse reaction to blood administration, such as fever, rash, or hemolysis
* Veteran does not speak or understand English
* Veteran hemodynamically unstable or in cardiogenic shock for \>48 hours after the index procedure
* Veteran participating in another interventional trial whose objective is to evaluate the effect of transfusion on outcomes
* Pregnancy in female Veterans
* Veteran is a prisoner or in custody of law enforcement
* Prior randomization in the CSP#599
* Patients who are known to have tested positive for COVID-19 and have not recovered prior to consent will not be consented. Any participant who is known to have a positive COVID-19 test during the screening process and has not recovered will be excluded prior to randomization.
B: Inclusion Criteria:

* Aged ≥ 18 years
* Recent acute myocardial infarction, with or without ST- segment elevation, with a combination of ischemic symptoms occurring in the past 48 hours,before the MI related admission, and elevation of biomarkers of myocardial injury (troponin)
* Anemia Hb ≤ 10g / dL but \> 7 g/dL on Hb, measured at any time during the index hospital admission for MI.
* Written informed consent
* Coverage for medical insurance.

Exclusion Criteria:

* Shock (SBP \< 90 mmHg with clinical signs of low output or patients requiring inotropic agents)
* MI occurring post-percutaneous coronary intervention (PCI) or post-coronary artery bypass graft (CABG) (i.e. type IV or V Acute MI according to the 2012 Universal Definition of MI
* Life-threatening or massive ongoing bleeding (as judged by the investigator)
* Any blood transfusion in the previous 30-days
* any known malignant hematologic disease Note: Sickle cell disease, thalassemia and anemia due to chronic renal failure (even under EPO) are not an exclusion criteria
C: Inclusion Criteria:

* age 18 or older;
* STEMI (ST segment elevated myocardial infarction)
* NSTEMI (Non ST segment elevation myocardial infarction)
* unstable angina
* stable coronary artery disease (undergoing cardiac catheterization during the index hospitalization);
* written informed consent has been obtained
* hemoglobin concentration less than 10 g/dL at the time of random allocation.

Exclusion Criteria:

* bleeding cannot be controlled at the cardiac catheterization puncture site and/or require surgery to repair vessel
* retroperitoneal bleeding requiring surgery
* clinically important hemodynamic instability based on the judgment of the treating physician
* terminal malignancy or life expectancy less than 6 months
* scheduled for cardiac surgery within the next 30 days
* symptomatic at the time of randomization
* declines blood transfusion
* history of a clinically significant transfusion reaction
* inability to provide informed consent;
* enrolled in a competing study
* previous participation in the MINT trial
* any patient who in the judgment of the research team should not be enrolled in the trial. This would include, but not be limited to, factors such alcohol or drug dependence, or psychiatric illness.
D: Inclusion Criteria:

* Age 18 or older
* Planned cardiac surgery using cardiopulmonary bypass
* Informed consent obtained
* Preoperative European System for Cardiac Operative Risk Evaluation (EuroSCORE I) of 6 or more

Exclusion Criteria:

* Patients who are unable to receive or who refuse blood products
* Patients who are involved in a preoperative autologous pre-donation program
* Patients who are having a heart transplant or having surgery solely for an insertion of a ventricular assist device
* Pregnancy or lactation (a negative pregnancy test must be obtained prior to randomization for women of childbearing potential.)
* Patients who are unable to receive or who refuse blood products

Answer: C