Deux injections d’érythropoïétine corrigent une anémie modérée chez la plupart des patients en attente d’une opération orthopédique

Abstract

B Ba ac ck kg gr ro ou un nd d: : The primary objective of this study was to assess the number of erythropoietin (EPO) injections required to reach a hematocrit (Ht) of 40% in moderately anemic patients. The secondary objective was to compare this strategy with autologous blood donation (ABD) in elective orthopedic surgery in terms of red blood cell (RBC) production.S St tu ud dy y d de es si ig gn n a an nd d m me et th ho od ds s: : 93 patients with a baseline Ht between 30 and 39% were randomized into two groups the day of the preoperative assessment. In the EPO group, patients received 40,000 UI/week sc until they reached a maximal Ht of 40%. In the ABD group, a RBC pack was collected every week as long as the Ht was above 33%.R Re es su ul lt ts s: : Two EPO injections were necessary to reach a 40% Ht in 63% of the patients. It was possible to collect two RBC packs in 45% of the patients in the ABD group. Volume of RBC production was significantly higher in the EPO group: 268 ± 142 mL vs 141 ± 129 (P = 0.0001). In the EPO group, Ht was significantly higher on days one and three after surgery and at discharge. The energy score was better in the EPO group. In the ABD group, 12.6% patients vs 6.5% in the EPO group received allogeneic transfusion (ns).C Co on nc cl lu us si io on n: : Only two EPO injections were sufficient to reach a Ht of 40% in the majority of patients. Therefore, to improve cost/effectiveness, the number of EPO injections should be related to baseline Ht instead of the four injections recommended in the product monograph. Objectif : Évaluer le nombre d'injections d'érythropoïétine (EPO) nécessaires pour atteindre un hématocrite (Ht) de 40 % chez des patients modérément anémiques. Aussi, comparer cette stratégie avec le don de sang autologue (DSA) en chirurgie orthopédique réglée en termes de production de globules rouges (GR). Méthode : Des patients (n = 93) présentant un Ht de base de 30 à 39 % ont été répartis en deux groupes le jour de l'évaluation

Potential Cost Saving of Epoetin alfa in Elective Hip or Knee Surgery due to Reduction in Blood Transfusions and Their Side Effects: A Discrete-Event Simulation Model

“…The data for the outcomes length of stay and pneumonia are observational while the effectiveness of EPO, autologous blood donation and no blood conservation are taken from randomized control trials. In case of EPO the effectiveness on preoperative Hb was taken from randomized control trials [22], [31] and the reduction on transfusion rate from a meta-analysis consisting of 5 randomized trials [48]. We cannot comment on what the relative contributions of preoperative iron therapy and intraoperative measures were, since there are no published data from randomized clinical trials fitting the situation simulated.…”

“…Each injection increases the patient's Hb level by an amount randomly determined from a distribution of Hb increase from EPO injections in a randomized study reported by Rosencher et al [22]. In this study the patients received up to 3 injections (2 injections on average) until an Hb level of 13.3 g/dl was reached.…”

“…One such study, Rosencheretal. 2005, demonstrated epoetinalfa's ability to raise hemoglobin (Hb) prior to surgery with only two injections of 40,000 IU [22], [23]. This regimen may reflect current European clinical practice and thus newer cost analyses of EPO are warranted.…”

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

“…Adverse events have been reported in 5% of patients that have been treated with EPO. These complications include deep venous thrombosis (DVT), pulmonary embolism (PE), fever, hypokalemia, urinary tract infection, nausea, hypoxia, and vomiting[39-41]. Briefly, EPO can reduce the need for ABTs in high-risk patients undergoing TKA; however, it was not found to be cost-effective compared to other blood conservation methods[42].…”

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

“…Preoperative anemia is a risk factor that increases postoperative morbidity and mortality, and is known as a cause of iron deficiency in more than 1/3 of cases12,13). After evaluating the conditions and causes of anemia according to serum hemoglobin and ferritin concentrations, correction of anemia status is recommended from 4 weeks prior to surgery using iron, vitamin B12, folic acid, erythropoietin and others14,15,16). Adjustment of antiplatelet or anticoagulant agents such as aspirin, heparin, warfarin and clopidogrel are suggested for reducing intra- and post-operative bleeding.…”