Effects of Preoperative Intravenous Erythropoietin Plus Iron on Outcome in Anemic Patients After Cardiac Valve Replacement

Cladellas, Mercè; Farré, Núria; Comín‐Colet, Josep; Gómez, Miquel; Meroño, Oona; Bosch, Mark; Vila, Joan; Molera, Rosa; Segovia, Anna; Bruguera, Jordi

doi:10.1016/j.amjcard.2012.05.036

Cited by 98 publications

(67 citation statements)

References 23 publications

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“…Tables 1, 2, and 4). In cardiac surgery, conflicting results have been found depending on whether intravenous iron was given with or without concomitant rHuEPO [31, 32]. Most guidelines from professional associations and international consensus documents recommend the administration of intravenous iron for the management of perioperative anemia [5, 14, 33-35].…”

Section: Treatment Options For Iron Deficiencymentioning

confidence: 99%

Management of Perioperative Iron Deficiency Anemia

et al. 2019

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Preoperative anemia affects 30–40% of patients undergoing major surgery and is an independent risk factor for perioperative blood transfusion, morbidity, and mortality. Absolute or functional iron deficiency is its leading cause. Nonanemic hematinic deficiencies are also prevalent and may hamper preoperative hemoglobin optimization and/or recovery from postoperative anemia. As modifiable risk factors, anemia and hematinic deficiencies should be detected and corrected prior to major surgical procedures. Postoperative anemia is even more common (up to 80–90%) due to surgery-associated blood loss, inflammation-induced blunted erythropoiesis, and/or preexisting anemia. Preoperative oral iron may have a role in mild-to-moderate anemia, provided there is sufficient time (6–8 weeks) and adequate tolerance of oral preparations. Postoperative oral iron is of little value and rife with gastrointestinal adverse events. Intravenous iron should preferentially be used in cases of moderate-to-severe iron deficiency anemia, concomitant use of erythropoiesis-stimulating agents, short time to surgery or nonelective procedures, and for postoperative anemia management. Minor infusion reactions to intravenous iron are rare, the incidence of severe anaphylactic reactions is extremely low, and there is no increase in infections with intravenous iron. Currently available intravenous iron formulations allowing administration of large single doses are preferred.

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Section: Treatment Options For Iron Deficiencymentioning

confidence: 99%

Management of Perioperative Iron Deficiency Anemia

et al. 2019

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“…Interestingly, the main cause of death in patients with anemia was infection, but patients with hemoglobin.14 g/dl were more likely to die from cardiovascular causes. Although anemia has been extensively shown as an independent risk factor for postoperative infection in both cardiac and noncardiac surgery (13,14,19,21,24), our study showed that patients with higher hemoglobin die mostly from cardiac complications. This fact, however, can be explained by a low rate of sepsis, sepsis-related, and overall mortality in this subgroup, leaving cardiovascular events as the leading cause of death.…”

Section: Discussionmentioning

confidence: 82%

“…Moreover, the study by Cladellas et al (21) showed that combined therapy with intravenous erythropoietin and iron administered before valvular cardiac surgery in patients with anemia was associated with a significant improvement in postoperative outcomes and a significant decrease in need for red blood cell transfusions. However, in the study, only 14% of patients in both intervention (75 patients) and observation (59 patients) cohorts had preoperative creatinine levels.1.5 mg/dl, and eGFR data were not provided (21). Recently, several randomized control trials have led to a major reassessment of anemia management in CKD: the Normal Hematocrit study in patients on hemodialysis with clinical signs of congestive heart failure or ischemic heart disease, studies from Europe (Cardiovascular Risk Reduction by Early Anemia Treatment with Epoetin-b) and the United States (Correction of Hemoglobin and Outcomes in Renal Insufficiency) in patients before dialysis, and finally, the Trial to Reduce Cardiovascular Events with Aranesp Therapy study on patients with diabetes, CKD, and anemia.…”

Section: Discussionmentioning

confidence: 99%

“…However, none of these studies was focused on or specifically designed to detect a relationship between preoperative hemoglobin and outcomes of cardiac surgery in patients with significant CKD. Anemia is common in patients with CKD, and some studies suggested that treatment with ESAs and intravenous iron can improve left ventricular ejection fraction, renal function, and functional capacity in patients with heart failure and anemia (17)(18)(19)(20)(21). Moreover, the study by Cladellas et al (21) showed that combined therapy with intravenous erythropoietin and iron administered before valvular cardiac surgery in patients with anemia was associated with a significant improvement in postoperative outcomes and a significant decrease in need for red blood cell transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…Anemia is common in patients with CKD, and some studies suggested that treatment with ESAs and intravenous iron can improve left ventricular ejection fraction, renal function, and functional capacity in patients with heart failure and anemia (17)(18)(19)(20)(21). Moreover, the study by Cladellas et al (21) showed that combined therapy with intravenous erythropoietin and iron administered before valvular cardiac surgery in patients with anemia was associated with a significant improvement in postoperative outcomes and a significant decrease in need for red blood cell transfusions. However, in the study, only 14% of patients in both intervention (75 patients) and observation (59 patients) cohorts had preoperative creatinine levels.1.5 mg/dl, and eGFR data were not provided (21).…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Hemoglobin and Outcomes in Patients with CKD Undergoing Cardiac Surgery

Shavit¹,

Hitti

Silberman

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Preoperative anemia adversely affects outcomes of cardiothoracic surgery. However, in patients with CKD, treating anemia to a target of normal hemoglobin has been associated with increased risk of adverse cardiac and cerebrovascular events. We investigated the association between preoperative hemoglobin and outcomes of cardiac surgery in patients with CKD and assessed whether there was a level of preoperative hemoglobin below which the incidence of adverse surgical outcomes increases.Design, setting, participants, & measurements This prospective observational study included adult patients with CKD stages 3-5 (eGFR,60 ml/min per 1.73 m 2 ) undergoing cardiac surgery from February 2000 to January 2010. Patients were classified into four groups stratified by preoperative hemoglobin level: ,10, 10-11.9, 12-13.9, and $14 g/dl. The outcomes were postoperative AKI requiring dialysis, sepsis, cerebrovascular accident, and mortality.Results In total, 788 patients with a mean eGFR of 43.5613.7 ml/min per 1.73 m 2 were evaluated, of whom 22.5% had preoperative hemoglobin within the normal range (men: 14-18 g/dl; women: 12-16 g/dl). Univariate analysis revealed an inverse relationship between the incidence of all adverse postoperative outcomes and hemoglobin level. Using hemoglobin as a continuous variable, multivariate logistic regression analysis showed a proportionally greater frequency of all adverse postoperative outcomes per 1-g/dl decrement of preoperative hemoglobin (mortality: odds ratio, 1.38; 95% confidence interval, 1.23 to 1.57; P,0.001; sepsis: odds ratio, 1.31; 95% confidence interval, 1.14 to 1.49; P,0.001; cerebrovascular accident: odds ratio, 1.31; 95% confidence interval, 1.00 to 1.67; P=0.03; postoperative hemodialysis: odds ratio, 1.38; 95% confidence interval, 1.11 to 1.75; P,0.01). Moreover, preoperative hemoglobin,12 g/dl was an independent risk factor for postoperative mortality (odds ratio, 2.6; 95% confidence interval, 1.1 to 7.3; P=0.04).Conclusions Similar to the general population, preoperative anemia is associated with adverse postoperative outcomes in patients with CKD. Whether outcomes could be improved by therapeutically targeting higher preoperative hemoglobin levels before cardiac surgery in patients with underlying CKD remains to be determined.

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