Erythropoietic agents for anemia of critical illness

Shermock, Kenneth M.; Horn, Ed; Rice, Ted L.

doi:10.2146/ajhp070225

Cited by 8 publications

(5 citation statements)

References 49 publications

(90 reference statements)

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“…Their model assumed that there would be a significant increase in infections associated with blood transfusions. Shermock et al, 29 although using the same data, did not find EPO to be cost‐effective. Chui et al 32 used data from the EPO‐3 trial 30 .…”

Section: Resultsmentioning

confidence: 92%

“…With an average of 40 000 units per dose, the price of one single dose is around $450 28 . Two studies performed a formal cost‐effectiveness analysis in 2005 27,29 . Both studies predated the largest study of erythropoietin in critically ill patients 30 .…”

Section: Resultsmentioning

confidence: 99%

“…28 Two studies performed a formal cost-effectiveness analysis in 2005. 27,29 Both studies predated the largest study of erythropoietin in critically ill patients. 30 These studies both used data from the EPO-1 and EPO-2 trials.…”

Section: Narrative Review 441 | Cost-effectivenessmentioning

confidence: 99%

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Erythropoiesis‐stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta‐analysis

Wijnberge

Rellum

Bruin

et al. 2020

Transfusion Medicine

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Objectives: The primary objectives of this meta-analysis in critically ill adult patients admitted to the intensive care unit (ICU) were to analyse whether erythropoiesisstimulating agents (ESAs) reduced the number of patients receiving red blood cell (RBC) transfusion and resulted in a change in haemoglobin (Hb) concentration. Our secondary objectives were adverse events and mortality. Background: Anaemia is common in ICU patients, and currently, the standard therapy is RBC transfusion, which is known to be associated with adverse events. ESA could potentially reduce the need for RBC transfusion. Methods: EMBASE, Cochrane and PubMed were searched up to January 2020. Results: A total of 1357 articles were identified, of which 18 articles met the inclusion criteria for the qualitative synthesis. Eight of these studies were used in the meta-analyses. Comparing ESA vs control group, there was a small reduction in the proportion of patients who received one or more RBC transfusions (relative risk [RR] 0.88; confidence interval [CI] 0.78-1.00, moderate certainty). The change in Hb concentration was trivial (mean difference −0.31 g/dL; CI −0.51 to −0.05, high certainty). The number of serious adverse events (RR 1.02; 0.90-1.15, low certainty) and the overall shortterm mortality were similar (RR 0.80; CI 0.61-1.05, low certainty) between the groups. Conclusion: ESA resulted in a small reduction in the proportion of patients transfused and a trivial increase in haemoglobin concentration, both of questionable clinical relevance, without impacting adverse events or mortality. These results do not support the routine use of ESA to treat anaemia in critically ill adults.

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Section: Resultsmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

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Erythropoiesis‐stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta‐analysis

Wijnberge

Rellum

Bruin

et al. 2020

Transfusion Medicine

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“…Those studies were relatively small, but no adverse outcomes were reported in patients who received ESA therapy . Interestingly, the cost of ESAs was also cited as a limitation to their use in critically ill adult patients with anemia . Further trials are needed to determine whether these approaches are safe and effective for selected pediatric and adult patient populations.…”

Section: Special Considerations For Pediatric Patientsmentioning

confidence: 99%

Bloodless medicine: current strategies and emerging treatment paradigms

Resar

Wick²,

Almasri³

et al. 2016

Transfusion

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“…[34][35][36][37][38] Interestingly, the high cost of ESAs was also noted as a significant limitation to their use in critically ill adult patients with anemia. 39 Further studies are needed to determine whether these approaches are safe and effective for selected pediatric and adult patient populations.…”

Section: Special Considerations For Pediatric Patientsmentioning

confidence: 99%

Bloodless medicine: what to do when you can't transfuse

Resar¹,

Frank

2014

Hematology

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A better understanding of risks associated with allogeneic blood transfusions (ABTs), along with a growing population of patients who do not accept transfusions, have led to the emergence of new treatment paradigms with "bloodless medicine." In this chapter, we review prior studies describing management and outcomes in patients who refuse transfusion (referred to as "bloodless patients" herein) and summarize the approaches used at our institution. Bloodless management for surgical patients includes treatment of preoperative anemia, use of autologous blood salvage, and minimizing blood loss with procedures. Other adjuncts for both medical and surgical patients include minimizing blood loss from laboratory testing using pediatric phlebotomy tubes and conservative testing. Anemia can be treated with erythropoiesis-stimulating agents, as well as iron, folate, and B12 when indicated. Although there are limited retrospective studies and no prospective studies to guide management, prior reports suggest that outcomes for surgical patients managed without ABTs are comparable to historic controls. A recent risk-adjusted, propensitymatched, case-control study of outcomes of all hospitalized patients who refused ABT at a large academic health center showed that bloodless management was not an independent predictor of adverse outcomes. Surprisingly, there was a lower overall mortality in the bloodless group and discharge hemoglobin levels were similar for both bloodless and control groups. Further research is now needed to optimize therapy and identify novel interventions to manage bloodless patients. Lessons learned from bloodless patients are likely to benefit all patients given recent evidence suggesting that patients who avoid ABTs do as well, if not better, than those who accept transfusions. Learning Objectives• To describe patient populations for whom transfusions are not an option • To discuss prior studies with outcomes and "bloodless medicine" • To outline currently available approaches to manage anemia or bleeding in "bloodless patients" • To discuss areas in need of further research to advance bloodless medicine

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Erythropoietic agents for anemia of critical illness

Cited by 8 publications

References 49 publications

Erythropoiesis‐stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta‐analysis

Erythropoiesis‐stimulating agents as replacement therapy for blood transfusions in critically ill patients with anaemia: A systematic review with meta‐analysis

Bloodless medicine: current strategies and emerging treatment paradigms

Bloodless medicine: what to do when you can't transfuse

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