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Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-blinded Placebo-controlled Trial. | LitMetric

AI Article Synopsis

  • - The study examined whether giving patients intravenous iron before and after complex cardiac surgery could lower the need for packed red blood cell (pRBC) transfusions, which are common due to postoperative iron deficiency anemia.
  • - Patients were divided into two groups: one received iron infusions while the other got a placebo; results showed similar transfusion rates (60.4% control vs. 57.2% iron).
  • - Although the iron group had better hemoglobin levels and increased iron stores post-surgery, the expected reduction in transfusions did not occur, possibly due to higher levels of hepcidin affecting iron metabolism.

Article 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 20 mg/kg (n = 103) or placebo (n = 101) twice during the perioperative period: 3 days 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 3 weeks postoperatively was higher in the iron group than in the control group (11.6 ± 1.5 g/dL vs 10.9 ± 1.4 g/dL, P < 0.001). The iron group showed higher reticulocyte count [205 (150-267)×103/μL vs 164 (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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Source
http://dx.doi.org/10.1097/SLA.0000000000005011DOI Listing

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