For patients with acute brain injury, a liberal transfusion strategy is associated with a lower risk of unfavorable neurological outcomes, according to new research. The Phase III TRAIN randomized clinical trial, which was conducted across 22 countries, included 850 patients with traumatic brain injury, aneurysmal subarachnoid hemorrhage, or intracerebral hemorrhage, plus hemoglobin levels below 9 g/dL. The patients were treated within the first 10 days after injury and were expected to stay in the intensive care unit for at least 72 hours. Patients were randomized to a liberal transfusion strategy, in which the transfusion was triggered by hemoglobin <9 g/dL (n=408) or to a restrictive strategy in which transfusion was triggered by hemoglobin <7 g/dL (n=442) over a 28-day period. For the 806 patients with data on the primary outcome  - the occurrence of an unfavorable neurological outcome, a Glasgow Outcome Scale Extended score between 1 and 5, at 180 days after randomization – the data favored patients in the liberal transfusion strategy group. In all, 62.6% of patients in the liberal transfusion strategy group had an unfavorable neurological outcome at 180 days compared with 72.6% of patients in the restrictive transfusion strategy group. In addition, 8.8% of patients in the liberal strategy group and 13.5% of those in the restrictive strategy group had at least one cerebral ischemic event.