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IV iron treatment lowers transfusions in cardiac surgery
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Patients with preoperative anemia or iron deficiency receiving a very short-term treatment including IV iron before elective cardiac surgery had a decreased need for red blood cell transfusions, according to findings published in The Lancet.
Donat R. Spahn, MD, and colleagues sought to determine whether immediate preoperative treatment could result in reduced perioperative red blood cell (RBC) transfusions and improved outcomes.
“A systematic assessment and treatment of anemia and iron deficiency before cardiac surgery is currently lacking and not an integral part of the preoperative standard workup in most health care systems,” Spahn, a professor and chairman at the Institute of Anaesthesiology at the University of Zurich and University Hospital Zurich, and colleagues wrote. “This study addressed the hypothesis that an immediate preoperative treatment of anemia or isolated iron deficiency could result in reduced perioperative RBC transfusions an in an improved perioperative outcome.”
The researchers analyzed data from the single-center, double-masked, parallel-group controlled study that consisted of patients having elective cardiac surgery with anemia (hemoglobin concentration < 120 g/L in women and < 130 g/L in men) or isolated iron deficiency (ferritin C 100 µg/L and no anemia). Among the cohort, 505 patients underwent randomization and 484 were included in the intention-to-treat analysis after others were excluded because they did not undergo surgery or for other reasons.
The participants were stratified into treatment groups with placebo or a combination treatment consisting of a slow infusion of 20 mg/kg ferric carboxymaltose, 40,000 U subcutaneous erythropoietin alpha, 1 mg subcutaneous vitamin B12 and 5 mg oral folic acid before surgery, Spahn and colleagues wrote. The primary outcome was the number of RBC transfusions in the first 7 days.
Combination treatment significantly reduced RBC transfusions during the first 7 days from a median of 1 U in the placebo group (interquartile range [IQR], 0-3) to 0 U in the treatment group (IQR, 0-2; OR = 0.7; 95% CI, 0.5-0.98), the researchers wrote. RBC transfusions were also lower in the treatment group at postoperative day 90 (P = .018).
In the first 7 days, patients in the treatment group had higher hemoglobin concentration, higher reticulocyte count and higher reticulocyte hemoglobin content, despite fewer RBC units transfused, Spahn and colleagues wrote.
There were fewer combined allogenic transfusions in the treatment group (0; IQR, 0-2) compared with the placebo group (1; IQR, 0-3) during the first 7 days (P = .038) and the first 90 days (P = .019), the researchers wrote.
Serious adverse events were similar in the treatment and placebo groups (P = .56), Spahn and colleagues wrote. – by Earl Holland Jr.
Disclosures: This study was funded by Vifor Pharma and the Swiss Foundation for Anaesthesia Research. Spahn reports he received institutional research grants from CSL Behring and Vifor Pharma. Please see the study for all other authors’ relevant financial disclosures.
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