Recombinant human erythropoietin administration in cardiac surgery

Abstract

Recombinant human erythropoietin induces erythropoiesis rapidly, even when it is used with a low single dose just 4 days before the operation. No adverse reactions were seen with this kind of recombinant human erythropoietin treatment.

Erythropoietin use and abuse

“…For instance, cardiothoracic surgery[42] or orthopedic surgery[43] may cause up to a 20% loss of total blood volume. A recent study showed that in patients who were ineligible for autologous donation, a low dose of rhEPO (150 IU/kg/week) given 3–4 weeks before surgery reduced the blood transfusion requirement by nearly 50%.…”

Hemotherapy in Cardiac Surgery

“…This efficacy can be enhanced by stimulation of erythropoiesis during blood donation, but this is used only selectively because of the potential of thrombotic cardiovascular events and costs [11,12]. The use of erythropoietin is also limited by the necessity of starting its administration 3 weeks before surgery [13]. A short course erythropoietin was also used several days before cardiac operation in anemic patients (haemoglobin < 13 g/dl) without autologous predonation [14,15].…”

Recombinant Human Erythropoeitin

“…1 Although there are at least 13 previous RCTs that have investigated if receiving perioperative rhEPO significantly decreases transfusions in cardiac surgical patients, the timing, route of administration, and dose of rhEPO varied substantially between these studies. 3,5,6 Yoo et al 's preoperative 500 IU/kg IV rhEPO intervention on day 1 significantly decreased overall perioperative transfusion rates in anemic patients undergoing cardiac valve surgery, but the subjects in both the rhEPO and placebo arms of the study were still anemic on the day of surgery and underwent similar rates of intraoperative PRBC transfusion. The bulk of the between-group differences in PRBC transfusions occurred during postoperative days 1-4.…”

“…Prior studies of rhEPO have enrolled populations of primarily coronary artery bypass graft surgery patients who were not selected for having preoperative anemia. [3][4][5][6] Still, 59% of the patients in the rhEPO intervention group received perioperative PRBC transfusions, suggesting that the work by Yoo et al should provide a starting point for future studies designed to test alternative rhEPO blood conservation approaches that could reduce PRBC use even further. Mitigating allogeneic PRBC transfusions, particularly in higher risk cardiac surgical groups, is important for reducing risks of transfusion-related infections and immunologic reactions, and for decreasing consumption of a limited health care resource.…”

“…A prior RCT that assessed rhEPO given at a dose of 100 IU/kg IV 4 days before coronary artery bypass grafting surgery found that preoperative hemoglobin was significantly higher in the rhEPO group compared with the control group. 6 With the objective of also addressing the likelihood of intraoperative transfusion, it seems warranted to conduct future large studies of preoperatively anemic subjects in order to compare perioperative transfusion rates for subjects receiving a single dose of rhEPO 3-4 days before valve surgery with rates in subjects receiving a single dose of rhEPO 1 day before surgery. Furthermore, since Yoo and colleagues argue that preoperative day 1 rhEPO administration is well timed to mitigate blunted erythrocyte production after CPB, an additional study arm could allow comparison of transfusion rates in subjects receiving single preoperative boluses of rhEPO to transfusion rates in subjects who receive rhEPO boluses at both earlier and later preoperative time points.…”