The Efficacy of Postoperative Iron Therapy in Improving Clinical and Patient-Centered Outcomes Following Surgery: A Systematic Review and Meta-Analysis

Perelman, Iris; Winter, Remington; Sikora, Lindsey; Martel, Guillaume; Saidenberg, Elianna; Fergusson, Dean

doi:10.1016/j.tmrv.2017.10.002

Cited by 31 publications

(35 citation statements)

References 53 publications

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“…[16][17][18] These clinical studies and a recently published small randomizedcontrolled trial (RCT) also support the finding that intravenous iron may be more effective than oral iron at restoring iron homeostasis. 17,19 Previous systematic reviews and meta-analyses have directly assessed the efficacy of ESAs with respect to RBC avoidance. [20][21][22] Nevertheless, these studies were limited in that: 1) all relevant RCTs that assessed the efficacy of preoperative ESA therapy on RBC transfusion avoidance were not included [20][21][22] ; 2) they included studies that utilized preoperative autologous donation (PAD), which may have confounded the impact of ESAs on RBC utilization and Hb outcomes 20,21 ; 3) one study did not perform a formal meta-analysis 22 ; 4) data on all cardiac and non-cardiac surgical patient populations were not included; and 5) complete data on serious adverse effects associated with ESA therapy were not included [20][21][22] (available as Electronic Supplementary Material [ESM] eAppendix, eTable 2 and eTable 3).…”

Section: Résumémentioning

confidence: 58%

“…It is also possible that the addition of ESAs to intravenous iron did not further reduce the incidence of RBC transfusion, as the increased efficacy of intravenous iron relative to oral iron may have negated any further therapeutic effect of ESA on optimal erythropoiesis. 17,19 Data from our analysis that refutes this argument include the finding that oral or intravenous iron alone did not dramatically increase the reticulocyte count (1% change with treatment). This suggests that inadequate time was allowed for the maximal therapeutic effect of iron or inadequate drug dosing prevented optimal erythropoiesis in patients treated with intravenous iron alone.…”

Section: Discussionmentioning

confidence: 86%

“…14 The efficacy of iron therapy alone has been assessed in previously published meta-analyses. [15][16][17][18] These analyses showed a trend toward increased postoperative hemoglobin concentration (Hb) but did not show a clear effect on red blood cell (RBC) transfusion avoidance. [16][17][18] These clinical studies and a recently published small randomizedcontrolled trial (RCT) also support the finding that intravenous iron may be more effective than oral iron at restoring iron homeostasis.…”

Section: Résumémentioning

confidence: 99%

“…[15][16][17][18] These analyses showed a trend toward increased postoperative hemoglobin concentration (Hb) but did not show a clear effect on red blood cell (RBC) transfusion avoidance. [16][17][18] These clinical studies and a recently published small randomizedcontrolled trial (RCT) also support the finding that intravenous iron may be more effective than oral iron at restoring iron homeostasis. 17,19 Previous systematic reviews and meta-analyses have directly assessed the efficacy of ESAs with respect to RBC avoidance.…”

Section: Résumémentioning

confidence: 99%

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Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis

Kei

Mistry

Curley

et al. 2019

Can J Anesth/J Can Anesth

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Purpose Iron restricted anemia is prevalent in surgical patients and is associated with an increased risk of allogeneic red blood cell (RBC) transfusion and adverse events. Treatment of anemia includes oral and intravenous iron and erythropoiesis stimulating agents (ESAs). More recent studies have focused on the use of intravenous iron as the primary approach to treating anemia. Nevertheless, the optimal treatment strategy for anemia remains to be established. Our primary objective was to evaluate the efficacy and safety of ESA and iron therapy relative to iron therapy alone in reducing RBC transfusion in surgical patients. Source We searched the Cochrane Library, MEDLINE, EMBASE, and ClinicalTrials.gov from inception to May 2018. We included randomized-controlled trials in which adult surgical patients received an ESA and iron, vs iron

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Section: Résumémentioning

confidence: 58%

Section: Discussionmentioning

confidence: 86%

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis

Kei

Mistry

Curley

et al. 2019

Can J Anesth/J Can Anesth

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“…In the postoperative phase, due to inflammatory-mediated hepcidin pathways downregulating enteric absorption, seven randomized controlled trials (RCTs) have shown that oral iron therapy is of no value. 36 The alternative is the use of parenteral iron therapy, whereas, in the past, older preparations containing dextran were associated with high rates of adverse effects and anaphylaxis. 37 Newer carbohydrate-based preparations have a much improved safety profile, 38 and if one were to compare head to head, then potentially an iron infusion has a lower adverse event rate compared with that associated with administering a single unit of blood.…”

Section: Iron Therapymentioning

confidence: 99%

Perioperative Anemia Management

Abeysiri

Chau

Richards

2019

Semin Thromb Hemost

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Anemia is increasingly recognized as an interventional hematological target in patients before major surgery. Preoperative anemia increases the need for perioperative blood transfusion, and there is now a well-recognized association with increased patient complications, length of hospital stay, and worse outcomes. Patient Blood Management (PBM) is a World Health Organization endorsed, evidence-based management bundle of care in transfusion hemostasis that focuses on three main aspects: anemia management, prevention of blood loss, and appropriate transfusion practice. Implementation of PBM guidelines has been accompanied by reduced transfusion needs and improved patient outcomes. In a patient presenting with preoperative anemia or at risk of transfusion, this should initiate a program of PBM that manages the patient through the entire operative period. We review the current evidence on the three pillars of PBM and highlight those aspects with the strongest evidence in support of their impact.

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Intravenous iron for critically ill children. Comparison of three dose regimens

Butragueño‐Laiseca,

de la Mata Navazo,

Sánchez Galindo

et al. 2023

Pediatric Blood & Cancer

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BackgroundAnemia is extremely common among patients admitted to pediatric intensive care. Alternative treatments to transfusions such as intravenous iron must be considered. There are no published data for a prospective intravenous (IV) iron study focused in the critically ill children. The objective is to examine the safety and efficacy of intravenous iron sucrose infusion to manage anemia in pediatric critical care. A secondary objective is to examine the effect of different dose regimens of iron sucrose (3, 5, and 7 mg/kg dose).ProcedureProspective investigation of intravenous iron sucrose utilization at a tertiary pediatric intensive care unit between October 2017 and November 2022.ResultsIn all 115 patients received a total of 616 infusions of IV iron. Transferrin saturation index (TSI) was the most common altered iron deficiency biomarker (91.8%). After IV iron treatment, hemoglobin showed a significant increase within a 30‐day follow‐up (9.2 vs. 11.6 g/dL, p < .001). There was also a significant improvement in TSI and serum iron (p < .001). Iron deficit replacement was higher in the 7 mg/kg dose group (94%) compared to 85.9% in the 5 mg/kg regimen and 77.5% in the lower dose group (p = .008), requiring less doses and a shorter time. Very few mild adverse reactions were reported (1.3% of infusions), with no differences between groups. The most frequent adverse effect was gastrointestinal in three cases. There were no anaphylaxis‐like or other serious/life‐threatening adverse effects.ConclusionsThis is the first study to evaluate intravenous iron therapy in pediatric critical care, providing preliminary evidence of safety and efficacy of IV iron sucrose. The 7 mg/kg dose regimen showed higher iron deficit replacement in a shorter time, which could be beneficial in critically ill children.

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The Efficacy of Postoperative Iron Therapy in Improving Clinical and Patient-Centered Outcomes Following Surgery: A Systematic Review and Meta-Analysis

Cited by 31 publications

References 53 publications

Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis

Efficacy and safety of erythropoietin and iron therapy to reduce red blood cell transfusion in surgical patients: a systematic review and meta-analysis

Perioperative Anemia Management

Intravenous iron for critically ill children. Comparison of three dose regimens

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