Comparison of intravenous and subcutaneous erythropoietin therapy for preoperative acquisition of blood for autologous transfusion in patients undergoing total arthroplasty

Introduction Cardiovascular disease is an important factor in the mortality and morbidity of patients with end-stage renal disease receiving hemodialysis. Although mineralocorticoid receptor antagonists may have potential benefits on the cardiovascular system, their safety for patients on hemodialysis remains unclear, considering the differences between the results of already performed clinical trials. Methods MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and PubMed databases were searched for relevant clinical trials. The Cochrane Collaboration assessment tool was employed to evaluate the quality of the randomized controlled trials. Revman 5.3 was used to perform the meta-analysis. Results Eleven studies (n¼379) were included in the systematic review and five randomized controlled trials were included in the meta-analysis (n¼248). Mineralocorticoid antagonists (MRAs) did not increase predialysis potassium levels significantly (0.11, 95% confidence interval À0.03 to 0.25, p ¼ 0.11). However, the studies included in this review reported inconsistently with respect to effects of mineralocorticoid receptor antagonists on blood pressure, left ventricular ejection fraction and left ventricular hypertrophy, and quantitative analysis was not performed due to insufficient data. One trial showed that the mineralocorticoid receptor antagonists were associated with decreased carotid intima-media thickness and other articles concluded that mineralocorticoid receptor antagonists had no effect on aortic stiffness. Conclusion It is safe to use low dose mineralocorticoid receptor antagonists on patients receiving hemodialysis, at the end of each session of hemodialysis, and close monitoring of serum potassium levels and possible side effects is necessary. The cardiovascular actions still need to be explored and large scale RCTs are in progress.

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“…Additionally, we calculated the Chi square and I 2 values to evaluate the heterogeneity among the studies according to the Cochrane Handbook. 20 …”

Section: Discussionmentioning

confidence: 99%

Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

et al. 2016

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“…Thrombus formation, hypertension and other side effects [1,3,12,13] may occur when EPO is administered to patients, and hypofibrinolytic activity has also been noted after total joint replacement [8]. We reported increases in platelet counts and rates of plasminogen activator inhibitor-1 which is involved in the acquisition of autologous blood using EPO [1].…”

Section: Discussionmentioning

confidence: 85%

“…and subcutaneous (s.c.) EPO therapy for preoperative acquisition of blood for autologous transfusion in patients scheduled for total arthroplasty [1]. We now report retrospectively the use of EPO for preoperative autologous blood donation for patients undergoing orthopedic surgery, including anemic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Storage of autologous blood prior to orthopedic surgery and for use in postoperative transfusions is on the increase [4,6]; however, this is not feasible for severely anemic patients (Hb below 10.9 g/ml). In Japan, some patients who undergo orthopedic surgery [1,3,7] have a Hb level below 9.9 g/dl on admission to the hospital and they may also have active rheumatoid arthritis (RA), iron deficiency anemia, malnutrition and other bone marrow insufficiencies, and be old.…”

Section: Introductionmentioning

confidence: 99%

“…Anemia is a major and predictable problem in the clinical care of elderly patients [1][2][3] requiring orthopedic surgery, such as primary and/or revisioned total hip arthroplasty and total knee arthroplasty. Administration of human recombinant erythropoietin (EPO) often alleviates anemia in surgical patients and increases hemoglobin (Hb) production, in close association with the dose of EPO [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

Kikuchi

Tan

Fukuoka

et al. 1998

Japanese Journal of Rheumatology

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Abstract--Our objectives was to evaluate erythropoietin (EPO) administration for preoperative autologous blood donation from anemic patients scheduled for orthopedic surgery. EPO was administered to 170 patients intravenously (i.v.) and subcutaneously (s.c.), To compare the difference between i.v. and s.c. administration the hemoglobin recovery rates per 10 000 IU of EPO (uHRR) administered i.v. and s.c. were calculated_ The i.v, and s.c. uHRR increased by 7.0 and 3.3%, respectively, in patients with admission Hb levels below 9.9 g/dt. The acquisition of scheduled blood was feasible for 54.7% and homologous blood transfusion was not needed for 88.7% of severely anemic patients. Eight patients required homologous blood transfusions and seven showed no response to EPO. We conclude that autologous blood transfusion with EPO treatment for anemic patients is safe and useful.

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Comparison of intravenous and subcutaneous erythropoietin therapy for preoperative acquisition of blood for autologous transfusion in patients undergoing total arthroplasty

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Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

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