Preoperative very short-term, high-dose erythropoietin administration diminishes blood transfusion rate in off-pump coronary artery bypass: A randomized blind controlled study

Cardiac Surgery Department, European Hospital, Rome, Italy.
The Journal of thoracic and cardiovascular surgery (Impact Factor: 4.17). 03/2010; 139(3):621-6; discussion 626-7. DOI: 10.1016/j.jtcvs.2009.10.012
Source: PubMed


Human recombinant erythropoietin has been used to obtain a rapid increase in red blood cells before surgery. Previously, the shortest preparatory interval has been 4 days, but at the European Hospital only 2.4 days on average separate hospitalization and surgery. We therefore proposed a randomized blind trial to test the efficacy of high-dose erythropoietin for very short-term administration.
All patients presenting with a diagnosis of isolated coronary vessel disease were randomized to either erythropoietin therapy or a control group. Patients with a creatinine level greater than 2 mg/dL or hemoglobin level greater than 14.5 g/dL were excluded. Hemoglobin values were collected preoperatively and on postoperative days 1 and 4. Blood loss and blood transfusion rate were recorded at the time of discharge.
We enrolled 320 consecutive patients in the study. No significant difference was found in preoperative parameters, postoperative blood loss, or mean preoperative hemoglobin levels. On postoperative day 4, mean hemoglobin was 15.5% higher in the erythropoietin group (10.70 +/- 0.72 g/dL vs 9.26 +/- 0.71 g/dL; P < .05). This group required 0.33 units of blood per patient, whereas the controls required 0.76 units per patient (risk ratio 0.43, P = .008).
A significant reduction in transfusion rate and a significant increase in hemoglobin values were observed in the erythropoietin group. No adverse events related to erythropoietin administration were recorded. A very short preoperative erythropoietin administration seems to be a safe and easy method to reduce the need for blood transfusions.

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    • "(30 days) Omran et al 2010 42 — JTCS 2010 220 CABG with ventral cardiac denervation CABG AF (in hospital) Veeger et al 2010 43 CABADAS ATS 2010 726 Aspirin/dipyridamole or warfarin after CABG Aspirin after CABG Composite: mortality CV, MI, revasc. (14 years) Weltert et al 2010 44 — JTCS 2010 320 Erythropoietin before CABG Usual care Blood transfusions (in hospital) AF indicates atrial fibrillation; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; ATS, Annals of Thoracic Surgery; CABG, coronary artery bypass grafting; Circ, Circulation; CO, cardiac output; CVA, cerebrovascular accident; DSWI, deep sternal wound infection; GI, gastrointestinal; IABP, intra-aortic balloon pump; IV, intravenous; JACC, Journal of American College of Cardiology; JTCS, Journal of Thoracic and Cardiovascular Surgery; MI, myocardial infarction; MR, mitral regurgitation; MV, mitral valve; NEJM, New England Journal of Medicine; PCI, percutaneous coronary intervention; revasc., repeat revascularization; SAVR, surgical aortic valve replacement; TAVR, transcutaneous aortic valve replacement. "
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    • "The use of erythropoietin is also limited by the necessity of starting its administration 3 weeks before surgery [13]. A short course erythropoietin was also used several days before cardiac operation in anemic patients (haemoglobin < 13 g/dl) without autologous predonation [14] [15]. In cardiac patients, there are certain contraindications for participation in autologous blood donation programmes; in addition to anaemia (haematocrit below 33%), they include critical aortic stenosis, idiopathic subaortal stenosis, ischaemic heart disease with unstable angina or with left main coronary artery stenosis, chronic NYHA class IV heart failure, ventricular rhythm disturbances on the day of blood collection and an acute heart attack. "

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