Erythropoietin risks, benefits

A recent trial revealed that administering recombinant human erythropoietin in critically ill anemic patients did not reduce the need for red-cell transfusion and was associated with an increase in thrombotic events.

However, investigators also found a greater increase in hemoglobin concentration for patients receiving erythropoietin than patients receiving placebo. Erythropoietin also reduced mortality – for trauma patients in particular, according to the prospective, randomized, placebo-controlled study.

The study included 1,460 medical, surgical or trauma patients admitted to the intensive care unit (ICU). Physicians administered erythropoietin or placebo to the patients weekly for up to 3 weeks.

“I think that there’s probably at this point no role for erythropoietin in non-trauma patients in the ICU, unless they have another indication for erythropoietin,” Howard L. Corwin, MD, study author, told Hem/Onc Today. “But it’s something that people should consider in trauma patients who are in the ICU more than 48 hours. … We did do a post-hoc analysis that suggests that the thrombotic risks are lessened in patients who are receiving prophylactic heparin at the time erythropoietin is started.”

This is one of several papers that have been coming out to which my sense is there’s been misinterpretation and great overreaction to the possible dangers of erythropoietin, where the benefits of erythropoietin are definite. … Quality of life is simply not being looked at. … Doctors ought to be able to assess an individual patient’s quality-of-life response to a therapy a lot better than basically having a randomized trial that shows a 1% or 2% increase in risk of a heart attack.

– Harry S. Jacob, MD, FRC(Hon)

For more information:

Corwin HL, Gettinger A, Fabian TC, et al. Efficacy and safety of epoetin alfa in critically ill patients. N Engl J Med. 2007;357:965-976.