ferric-carboxymaltose and Blood-Loss--Surgical

Patient blood management aims to maintain hemoglobin level, minimize blood loss, and avoid unnecessary blood transfusion. Ferric carboxymaltose, an intravenous iron agent, was included as a part of surgical patient blood management strategy. However, it is still controversial that ferric carboxymaltose can reduce transfusion requirements. The purpose of this systematic review and meta-analysis is to evaluate the benefits of perioperative ferric carboxymaltose on the postoperative hematological parameters and transfusion requirements.. Randomized controlled trials evaluating the effects of ferric carboxymaltose were searched through databases: MEDLINE, EMBASE, CENTRAL, CINAHL, Scopus, Web of Science, and KoreaMed. Meta-analysis was performed using random effect models.. A total of 8 studies (n = 471) were included in the final analysis. Postoperative hemoglobin was higher in the ferric carboxymaltose group than in the control group (mean difference [MD], 0.58 g/dL; 95% confidence interval [CI], 0.36 to 0.80; P < 0.00001). Postoperative serum ferritin and transferrin saturation were also higher in the ferric carboxymaltose group (MD, 373.85 μg/L; 95% CI, 298.13 to 449.56; P < 0.00001; MD, 10.35%; 95% CI, 4.59 to 16.10; P < 0.00001, respectively). However, there were no significant differences in the number of transfused patients, length of hospital stay, and adverse events between groups. Subgroup analysis revealed that adverse events were lower in the ferric carboxymaltose group than the oral iron group.. This study supports that ferric carboxymaltose may increase the postoperative hemoglobin level in surgical patients. However, transfusion requirements could not be reduced by ferric carboxymaltose. Optimal dose and time should be further analyzed.

Topics: Administration, Intravenous; Administration, Oral; Blood Loss, Surgical; Blood Transfusion; Ferric Compounds; Hemoglobins; Humans; Maltose; Perioperative Care; Postoperative Hemorrhage; Postoperative Period; Randomized Controlled Trials as Topic; Treatment Outcome

To determine if preoperative intravenous (IV) iron improves outcomes in abdominal surgery patients.. Preoperative iron deficiency anemia (IDA) occurs frequently; however if left untreated, increases the risk of blood transfusion allogeneic blood transfusion (ABT). Limited evidence supports IDA treatment with preoperative IV iron. This randomized controlled trial aimed to determine whether perioperative IV iron reduced the need for ABT.. Between August 2011 and November 2014, 72 patients with IDA were assigned to receive either IV iron or usual care. The primary endpoint was incidence of ABT. Secondary endpoints were various hemoglobin (Hb) levels, change in Hb between time points, length of stay, iron status, morbidity, mortality, and quality of life 4 weeks postsurgery.. A 60% reduction in ABT was observed in the IV iron group compared with the usual care group (31.25% vs 12.5%). Hb values, although similar at randomization, improved by 0.8 g/dL with IV iron compared with 0.1 g/dL with usual care (P = 0.01) by the day of admission. The IV iron group had higher Hb 4 weeks after discharge compared with the usual care group (1.9 vs 0.9 g/dL, P = 0.01), and a shorter length of stay (7.0 vs 9.7 d, P = 0.026). There was no difference in discharge Hb levels, morbidity, mortality, or quality of life.. Administration of perioperative IV iron reduces the need for blood transfusion, and is associated with a shorter hospital stay, enhanced restoration of iron stores, and a higher mean Hb concentration 4 weeks after surgery.

Topics: Abdominal Cavity; Aged; Anemia, Iron-Deficiency; Blood Loss, Surgical; Blood Transfusion; Body Mass Index; Digestive System Surgical Procedures; Female; Ferric Compounds; Follow-Up Studies; Humans; Injections, Intravenous; Length of Stay; Male; Maltose; Middle Aged; Perioperative Care; Postoperative Care; Quality of Life; Treatment Outcome

Topics: Abdomen; Administration, Intravenous; Anemia; Biomarkers; Blood Loss, Surgical; Blood Transfusion; Drug Administration Schedule; Ferric Compounds; Hematinics; Hemoglobins; Humans; Maltose; Randomized Controlled Trials as Topic; Risk Factors; Treatment Outcome

This retrospective study was performed to determine whether postoperative intravenous ferric carboxymaltose reduces transfusion amounts without influencing clinical outcomes in patients that have undergone hip surgery.. Between May 2014 and April 2016, the authors adopted a new perioperative blood management protocol involving the administration of intravenous ferric carboxymaltose after hip surgeries. One-to-one matching between the 150 patients treated during this period with 150 patients treated before initiation of the new protocol was performed by propensity scoring for age, sex, diagnosis, and type of hip surgery. Hematologic results and clinical outcomes in these two groups were compared.. Average amounts of perioperative blood loss were not different in the two groups. Ninety-two patients (61%) were transfused in the control group and 70 patients (47%) were transfused in the intravenous ferric carboxymaltose group. The average number of transfused blood units was significantly lower in the intravenous ferric carboxymaltose group (1.7 ± 2.7 units vs. 1.0 ± 1.2 units,. This study suggests that postoperative intravenous ferric carboxymaltose injection is associated with reduced transfusion amounts and that intravenous ferric carboxymaltose does not influence clinical outcomes after hip surgery.

Topics: Administration, Intravenous; Adult; Aged; Aged, 80 and over; Blood Loss, Surgical; Blood Transfusion; Female; Ferric Compounds; Hemoglobins; Hip Joint; Humans; Length of Stay; Male; Maltose; Middle Aged; Postoperative Care; Postoperative Complications; Propensity Score; Retrospective Studies; Young Adult

Erythropoietin (EPO) is proposed preoperatively to reduce blood transfusion in anemic patients (hemoglobin < 13 g/dL) scheduled for a major orthopedic surgery. New intravenous iron formulations allow infusion of higher doses, increasing EPO response. In that context, we evaluated in a before-after study (n = 62 and 65 patients for each period) a new EPO administration protocol (2 injections 4 and 3 weeks before surgery, and a third if hemoglobin <13 g/dL instead of <15 g/dL 2 weeks before surgery). After this protocol implementation, the mean (standard deviation) number of EPO injections decreased from 2.8 (0.5) to 2.2 (0.4)/patient (P < .0001) without changing transfusion rates (3% in the 2 periods).

Topics: Aged; Aged, 80 and over; Anemia; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biomarkers; Blood Loss, Surgical; Blood Transfusion; Drug Administration Schedule; Drug Compounding; Erythropoietin; Female; Ferric Compounds; Hematinics; Hemoglobins; Humans; Infusions, Intravenous; Injections, Subcutaneous; Male; Maltose; Middle Aged; Program Evaluation; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome