Academic Journal
Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-blinded Placebo-controlled Trial
| Title: | Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements: A Randomized, Double-blinded Placebo-controlled Trial |
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| Authors: | Jong Wook Song, Seung-Hyun Lee, Young Lan Kwak, Min-Yu Kim, Hye Bin Kim, Jae Kwang Shim, Sak Lee, Sarah Soh |
| Contributors: | Jong Wook Song, Sarah Soh, Jae-Kwang Shim, Sak Lee, Seung Hyun Lee, Hye Bin Kim, Min-Yu Kim, Young Lan Kwak, Kwak, Young Lan |
| Source: | Annals of Surgery. 275:232-239 |
| Publisher Information: | Ovid Technologies (Wolters Kluwer Health), 2021. |
| Publication Year: | 2021 |
| Subject Terms: | Male, Erythrocyte Transfusion / statistics & numerical data, Postoperative Complications / prevention & control, Disaccharides, Ferric Compounds, Perioperative Care, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Iron-Deficiency / prevention & control, Double-Blind Method, Humans, Prospective Studies, Ferric Compounds / administration & dosage, Cardiac Surgical Procedures, Disaccharides / administration & dosage, Anemia, Iron-Deficiency, Anemia, 3. Good health, Administration, Administration, Intravenous, Female, Intravenous, Erythrocyte Transfusion |
| Description: | 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. |
| Document Type: | Article |
| Language: | English |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000005011 |
| Access URL: | https://pubmed.ncbi.nlm.nih.gov/34171864 https://europepmc.org/article/MED/34171864 https://www.ncbi.nlm.nih.gov/pubmed/34171864 https://pubmed.ncbi.nlm.nih.gov/34171864/ |
| Rights: | CC BY NC ND |
| Accession Number: | edsair.doi.dedup.....9f52e9ce2f07ba256015524a121a719b |
| Database: | OpenAIRE |
| ISSN: | 15281140 00034932 |
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| DOI: | 10.1097/sla.0000000000005011 |