| Autor: |
Feagan, Brian G., Wong, Cindy J., Kirkley, Alexandra, Johnston, D.W.C., Smith, Frank C., Whitsitt, Paul, Wheeler, Susan L., Lau, Catherine Y., Feagan, B G, Wong, C J, Kirkley, A, Johnston, D W, Smith, F C, Whitsitt, P, Wheeler, S L, Lau, C Y |
| Předmět: |
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| Zdroj: |
Annals of Internal Medicine; 12/5/2000, Vol. 133 Issue 11, p845-854, 10p |
| Abstrakt: |
Background: The optimum regimen of epoetin alfa for prevention of allogeneic blood transfusion is unknown.Objective: To determine whether a modified regimen of epoetin alfa reduces allogeneic blood transfusion in patients undergoing hip arthroplasty.Design: Randomized, double-blind, multicenter trial comparing two modified dose regimens of epoetin alfa with placebo.Setting: 13 teaching hospitals and 4 community hospitals in Canada.Patients: 201 patients undergoing primary hip arthroplasty who had a hemoglobin concentration of 98 to 137 g/L and did not predonate blood.Intervention: Patients were assigned in a 3:5:5 ratio to receive four weekly doses of epoetin alfa, 40 000 U (high-dose; n = 44) or 20 000 U (low-dose; n = 79), or placebo (n = 78), starting 4 weeks before surgery. All patients received oral iron supplementation, 450 mg/d, for 42 or more days before surgery.Measurements: The primary end point was allogeneic transfusion. Secondary end points were thromboembolic events and change in reticulocyte count and hemoglobin concentration.Results: Both modified epoetin alfa regimens significantly reduced the need for allogeneic transfusion: Five (11.4%) patients in the high-dose group (P = 0.001) and 18 (22. 8%) patients in the low-dose group (P = 0.003) had transfusion, compared with 35 (44.9%) patients in the placebo group. The hematologic response was substantial in patients who received epoetin alfa. In the high-dose group, low-dose group, and placebo group, the preoperative increase in reticulocyte count was 58.8, 37. 0 and 1.8 x 10(9) cells/L (P < 0.001), respectively, and the increase in hemoglobin concentration was 19.5, 17.2, and 1.2 g/L (P < 0.001). The incidence of thromboembolic events did not differ among groups.Conclusions: Both modified epoetin alfa regimens were effective compared with placebo in reducing allogeneic transfusion in patients undergoing hip arthroplasty. Patients who received high-dose epoetin alfa had the lowest transfusion rate. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
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