Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-blinded Placebo-controlled Trial.
Ann Surg
; 275(2): 232-239, 2022 02 01.
Article
em En
| MEDLINE
| ID: mdl-34171864
ABSTRACT
OBJECTIVES:
We investigated whether routine perioperative intravenous iron replenishment reduces the requirement for packed erythrocytes (pRBC) transfusion. SUMMARY OF BACKGROUND DATA Patients undergoing complex cardiac surgery are at high risk of developing postoperative iron deficiency anemia, thus requiring transfusion, which is associated with adverse outcomes.METHODS:
Patients were randomized to receive either ferric derisomaltose 20âmg/kg (n = 103) or placebo (n = 101) twice during the perioperative period 3âdays before and after the surgery. The primary endpoint was the proportion of patients who received pRBC transfusion until postoperative day (POD) 10. Hemoglobin, reticulocyte count, serum iron profile, hepcidin, and erythropoietin were serially measured.RESULTS:
pRBC was transfused in 60.4% and 57.2% of patients in the control and iron group, respectively (P = 0.651). Hemoglobin concentration at 3âweeks postoperatively was higher in the iron group than in the control group (11.6 ± 1.5âg/dL vs 10.9 ± 1.4âg/dL, P < 0.001). The iron group showed higher reticulocyte count [205â(150-267)×103/µL vs 164â(122-207)×103/µL, P = 0.003] at POD 10. Transferrin saturation and serum ferritin were significantly increased in the iron group than in the control group (P < 0.001). Serum hepcidin was higher in the iron group than in the control group at POD 3 [106.3 (42.9-115.9) ng/mL vs 39.3 (33.3-43.6) ng/mL, P < 0.001]. Erythropoietin concentration increased postoperatively in both groups (P = 0.003), with no between-group difference.CONCLUSIONS:
Intravenous iron supplementation during index hospitalization for complex cardiac surgery did not minimize pRBC transfusion despite replenished iron store and augmented erythropoiesis, which may be attributed to enhanced hepcidin expression.
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Base de dados:
MEDLINE
Assunto principal:
Complicações Pós-Operatórias
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Transfusão de Eritrócitos
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Anemia Ferropriva
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Dissacarídeos
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Procedimentos Cirúrgicos Cardíacos
Idioma:
En
Ano de publicação:
2022
Tipo de documento:
Article