A randomized trial compared a liberal transfusion strategy (hemoglobin threshold of 10 g/dL) with a restrictive strategy (hemoglobin threshold of <8 g/dL) in 2016 patients aged 50 years or older with cardiovascular disease risk factors and hemoglobin levels below 10 g/dL after hip fracture surgery. The primary outcome was death or inability to walk without assistance at 60 days. Both strategies had similar outcomes, with no significant difference in death rates or walking ability. In-hospital acute coronary syndrome or death rates were also similar. Other complications were comparable between groups. The study found no benefit of a liberal strategy over a restrictive one in reducing mortality or functional disability in high-risk patients. Blood use was significantly lower in the restrictive group. The results suggest that a restrictive transfusion strategy is equally effective and safer, with fewer blood transfusions. The study highlights the importance of individualized transfusion decisions and supports a restrictive approach in high-risk patients. The findings contradict previous studies suggesting a benefit of higher hemoglobin thresholds, emphasizing the need for further research in this area.A randomized trial compared a liberal transfusion strategy (hemoglobin threshold of 10 g/dL) with a restrictive strategy (hemoglobin threshold of <8 g/dL) in 2016 patients aged 50 years or older with cardiovascular disease risk factors and hemoglobin levels below 10 g/dL after hip fracture surgery. The primary outcome was death or inability to walk without assistance at 60 days. Both strategies had similar outcomes, with no significant difference in death rates or walking ability. In-hospital acute coronary syndrome or death rates were also similar. Other complications were comparable between groups. The study found no benefit of a liberal strategy over a restrictive one in reducing mortality or functional disability in high-risk patients. Blood use was significantly lower in the restrictive group. The results suggest that a restrictive transfusion strategy is equally effective and safer, with fewer blood transfusions. The study highlights the importance of individualized transfusion decisions and supports a restrictive approach in high-risk patients. The findings contradict previous studies suggesting a benefit of higher hemoglobin thresholds, emphasizing the need for further research in this area.