Preoperative erythropoietin within a patient blood management program decreases both blood transfusion and postoperative anemia: a prospective observational study

Autor: Philippe Biboulet, Pierre Smilevitch, Gaëtan Dangelser, Caroline Motais, Oliver Karam, Xavier Capdevila, Guillaume Maissiat, Sophie Bringuier, Mathieu Pencole
Přispěvatelé: Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), University of Richmond, Institut des Neurosciences de Montpellier - Déficits sensoriels et moteurs (INM), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)
Rok vydání: 2020
Předmět:
Male
MESH: Anemia
Blood transfusion
Arthroplasty
Replacement
Hip
medicine.medical_treatment
030204 cardiovascular system & hematology
Postoperative Complications
MESH: Arthroplasty
Replacement
Knee
0302 clinical medicine
MESH: Postoperative Complications
hemic and lymphatic diseases
MESH: Arthroplasty
Replacement
Hip
Immunology and Allergy
Prospective Studies
Arthroplasty
Replacement
Knee
Prospective cohort study
MESH: Aged
MESH: Iron
MESH: Middle Aged
Anemia
[SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology
Hematology
Middle Aged
3. Good health
Tranexamic Acid
Anesthesia
Preoperative Period
Female
Tranexamic acid
medicine.drug
Blood management
Iron
Immunology
MESH: Blood Transfusion
MESH: Preoperative Period
03 medical and health sciences
medicine
Humans
Blood Transfusion
MESH: Erythropoietin
Erythropoietin
Aged
MESH: Humans
business.industry
Odds ratio
MESH: Tranexamic Acid
medicine.disease
Arthroplasty
MESH: Prospective Studies
MESH: Male
business
MESH: Female
030215 immunology
Zdroj: Transfusion
Transfusion, Wiley, 2020, 60 (8), pp.1732-1740. ⟨10.1111/trf.15900⟩
ISSN: 1537-2995
0041-1132
DOI: 10.1111/trf.15900
Popis: International audience; Background: In orthopedic surgery, a patient blood management program (PBM) has been proposed to reduce blood transfusion. The aim of this observational study was to assess, within a PBM, the specific efficacy of preoperative erythropoietin (EPO).Study design and methods: In a single hospital, 723 patients undergoing elective primary hip or knee arthroplasty were prospectively studied. The PBM included EPO if preoperative hemoglobin was lower than 13 g/dL, intraoperative administration of tranexamic acid, use of recommended transfusion thresholds, and postoperative infusion of iron. Blood transfusion and hemoglobin were noted until discharge. Major thromboembolic or cardiovascular events were assessed during admission and 1 month after discharge.Results: Transfusion was noted in 2.5% patients with EPO. Transfusion rate was higher in patient for whom EPO was not indicated (13.6% transfusion rate; odds ratio [OR], 13.7; 95% confidence interval [CI], 2.6-66; p = 10-3 ) or if erythropoietin was indicated but not administrated (36.8% transfusion rate; OR, 18.2; 95% CI, 3.9-84.5; p < 10-3 ). Hemoglobin was significantly higher during the postoperative period in patients with erythropoietin. At hospital discharge, 57% of patients were anemic if EPO was used compared to 88% when EPO was not indicated and 87% when EPO was indicated but not administered (p < 10-6 ). There were no significant differences in the odds of major complications between patients with or without EPO.Conclusions: Within a PBM, preoperative treatment of anemia with EPO decreased both the rate of blood transfusion and postoperative anemia. Further studies are necessary to confirm these results.
Databáze: OpenAIRE
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