Finding the Optimal Regimen for Short-Term Daily Recombinant Human Erythropoietin Treatment for Blood-Saving Purpose in Patients undergoing Unilateral Primary Total Hip Arthroplasty: A Double-Blinded Randomized Placebo-Controlled Trial

Abstract

Purpose: To find the best short-term daily rhEPO-based treatment protocols for blood-saving purpose in THA.Method: The patients were randomized to 1 of 3 interventions: Patients in group A received 10,000 IU (150IU/kg) of subcutaneous rhEPO (1 ml) daily from 5 days preoperatively to 3 days postoperatively (9 doses in total); Patients in group B received 1 ml of subcutaneous normal saline daily from 5 days preoperatively to 4 days preoperatively and then 10,000 IU (150IU/kg) of subcutaneous rhEPO daily till 3 days postoperatively (6 doses in total). Patients in group C received 1 ml of subcutaneous normal saline daily from 5 days preoperatively to one day preoperatively and then 10,000 IU (150IU/kg) of subcutaneous rhEPO daily from the day of surgery to 3 days postoperatively (4 doses in total). Results: 180 patients were included. On postoperative day one, patients in the group A showed significantly higher Hb level (108.4±11.4 g/L) than group B and C (107.8±8.4 and 103.9±8.8 g/L, respectively) (p<0.001), the Hb level in group B was also markedly higher than in group C (p=0.045). On postoperative day 3, no significant difference was found between group B and C in Hb level (98.7±10.5 and 94.9±8.7 g/L, respectively) (p=0.094), but the Hb level in group A (103.6±11.0 g/L) was still markedly higher than in group B and C. In terms of blood loss, no markedly difference was found in intraoperative blood loss among group A, B and C (78.3±22.4, 84.6±29.1, and 80.3±23.9 ml, respectively) (p=0.381), but on postoperative day one, the mean blood loss was significantly more in groups B and C (371.2±124.6, and 522.4±189.4 ml, respectively) than in group A (284.8±112.9 ml) (p<0.001), and group B had significantly less blood loss than group C (p<0.001). With respect to the total blood loss, group B and C had markedly more total blood loss (642.6±232.9, and 881.6±314.9 ml, respectively) than group A (514.5±204.6 ml) and group B had significantly less blood loss than group C (p<0.001) (Table 2). Only 2 patients in each group received allogeneic blood transfusion and each patient received 2 units of red blood cells, so, the transfusion requirements among the three groups were comparable.Conclusions: Daily small-dose of subcutaneous rhEPO administered from 5 days before THA could significantly decrease perioperative blood loss and improve postoperative Hb levels, without increasing risks of complications, when compared with the application of rhEPO from 3 days before THA or from the day of surgery. Therefore, we recommend the more practical and highly effective therapeutic regimen of small-dose of subcutaneous rhEPO daily from 5 days preoperatively to 3 days postoperatively for patients scheduled for THA.