Preoperative very short-term, high-dose erythropoietin administration diminishes blood transfusion rate in off-pump coronary artery bypass: A randomized blind controlled study
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.
Available from: Laura Drudi
- "(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. "
[Show abstract] [Hide abstract]
There is currently no accepted standard for reporting outcomes following cardiac surgery. The objective of this paper was to systematically review the literature to evaluate the current use and definition of perioperative outcomes reported in cardiac surgery trials.
Methods and results:
We reviewed 5 prominent medical and surgical journals on Medline from January 1, 2010, to June 30, 2014, for randomized controlled trials involving coronary artery bypass grafting and/or valve surgery. We identified 34 trials meeting inclusion criteria. Sample sizes ranged from 57 to 4752 participants (median 351). Composite end points were used as a primary outcome in 56% (n=19) of the randomized controlled trials and as a secondary outcome in 12% (n=4). There were 14 different composite end points. Mortality at any time (all-cause and/or cardiovascular) was reported as an individual end point or as part of a combined end point in 82% (n=28), myocardial infarction was reported in 68% (n=23), and bleeding was reported in 24% (n=8). Patient-centered outcomes, such as quality of life and functional classification, were reported in 29% (n=10). Definition of clinical events such as myocardial infarction, stroke, renal failure, and bleeding varied considerably among trials, particularly for postoperative myocardial infarction and bleeding, for which 8 different definitions were used for each.
Outcome reporting in the cardiac surgery literature is heterogeneous, and efforts should be made to standardize the outcomes reported and the definitions used to ascertain them. The development of standardizing outcome reporting is an essential step toward strengthening the process of evidence-based care in cardiac surgery.
Journal of the American Heart Association 08/2015; 4(8). DOI:10.1161/JAHA.115.002204 · 4.31 Impact Factor
Available from: Robert Wagner
- "The use of erythropoietin is also limited by the necessity of starting its administration 3 weeks before surgery . A short course erythropoietin was also used several days before cardiac operation in anemic patients (haemoglobin < 13 g/dl) without autologous predonation  . 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. "
Perioperative Considerations in Cardiac Surgery, 02/2012; , ISBN: 978-953-51-0147-5
[Show abstract] [Hide abstract]
ABSTRACT: To begin, we must agree on what we mean by a learning system and a learning control system. A system is called learning if the information pertaining to the unknown features of a process or its environment is acquired by the system, and the obtained experience is used for future estimation, recognition, classification, decision or control such that the performance of the system will be improved. A learning system is called a learning control system if the acquired information is used to control a process with unknown features (these standardized definitions are taken from Reference 1). The attribute of "learning" that is associated with learning systems, derives from psychological learning theories, especially reinforcement learning theories.
Decision and Control including the 13th Symposium on Adaptive Processes, 1974 IEEE Conference on; 01/1974
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.