Abstract
Purpose
To determine if early recovery from severe postoperative anemia is accelerated byiv iron therapy alone or in combination with recombinant erythropoietin (EPO).
Methods
In this double-blinded, placebo-controlled randomized study, consenting adult patients without preoperative anemia whose hemoglobin concentration (Hb) was 70 to 90 g·L-1 on the first day after cardiac or orthopedic surgery (POD 1) were assigned to one of three groups: control,iv iron alone (200 mg of iron sucrose on POD 1, 2, and 3) or in combination with EPO (600 U·kg-1 on POD 1 and 3). The primary outcome was increase in Hb (adjusted for red blood cell transfusions) from POD 1 to 7. Analysis was by intention-to-treat in patients for whom the primary outcome was available. Group effect was analyzed by the ANOVA test, and between-group differences were specified with a Duncan multiple-range test.
Results
The primary outcome was available in 31 of 38 randomized patients. The average POD 1 Hb was 84 ± 4 g·L-1. There were no between-group differences in outcomes except for higher reticulocyte counts on POD-7 in the combination group. The average adjusted one-week increases in Hb were 7 ± 8 g·L-1 in the control group (n = 10), 9 ± 9 g·L-1 in theiv iron group (n = 11), and 10 ± 14 g·L-1 in the combination group (n = 10). The average adjusted six-week increases in Hb were 37 ± 14 g·L-1 in the control group, 40 ± 7 g·L-1 in theiv iron group, and 45 ± 12 g·L-1 in the combination group.
Conclusion
Early postoperative treatment withiv iron alone or in combination with EPO does not appear to accelerate early recovery from postoperative anemia.
Résumé
Objectif
Vérifier si la récupération précoce ďune sévère anémie postopératoire est accélérée par le fer iv seul ou en combinaison avec de ľérythropoÏétine recombinante (EPO).
Méthode
Pour ľétude à double insu, randomisée et contrôlée contre placebo, des adultes sans anémie préopératoire, chez qui la concentration ďhémoglobine (Hb) était de 70 à 90 g·L-1 au premier jour post-opération cardiaque ou orthopédique (JPO 1), ont été assignés à ľun des trois groupes: témoin, fer iv seul (200 mg de sucrose ferreux aux JPO 1, 2 et 3) ou en combinaison avec de ľEPO (600 U·kg-1 aux JPO POD 1 et 3). Le résultat principal était une hausse de ľHb (ajustée pour les transfusions de culots globulaires) des JPO 1 à 7. Ľévaluation, pour les patients ayant atteint ce résultat, utilisait ľanalyse par intention de traiter. Ľeffet de groupe a été analysé par le test ANOVA test et les différences intergroupes ont été précisées avec le test à gamme multiple de Duncan.
Résultats
Le résultat principal était atteint chez 31 des 38 patients randomisés. La moyenne de ľHb au JPO 1 a été de 84 ± 4 g·L-1. Il n’y a pas eu de différence de résultat intergroupe sauf pour une numération plus élevée des réticulocytes au JPO 7 dans le groupe ďEPO. Les hausses moyennes ďHb ajustées sur une semaine ont été de 7 ± 8 g·L-1dans le groupe témoin (n = 10), 9 ± 9 g·L-1 avec le fer iv (n = 11) et 10 ± 14 g·L-1 avec ľEPO (n = 10). Les hausses moyennes ďHb ajustées sur six semaines ont été de 37 ± 14 g·L-1 chez les témoins, 40 ± 7 g·L-1 avec le fer iv et 45 ± 12 g·L-1 avec ľEPO.
Conclusion
Le traitement postopératoire précoce avec du fer iv seul ou en combinaison avec ľEPO ne semble pas hâter la récupération de ľanémie postopératoire.
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Karkouti, K., McCluskey, S.A., Ghannam, M. et al. Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia. Can J Anesth 53, 11–19 (2006). https://doi.org/10.1007/BF03021522
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DOI: https://doi.org/10.1007/BF03021522