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Article Dans Une Revue Anesthesiology Année : 2018

Preoperative Epoetin-α with Intravenous or Oral Iron for Major Orthopedic Surgery: A Randomized Controlled Trial

Pierre Smilevitch
  • Fonction : Auteur
Thibault Loupec
  • Fonction : Auteur
Caroline Thuile
  • Fonction : Auteur
Mathieu Pencole
  • Fonction : Auteur
Guillaume Maissiat
  • Fonction : Auteur
Gaëtan Dangelser
  • Fonction : Auteur

Résumé

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Preoperative administration of epoetin-α with iron is commonly used in anemic patients undergoing major orthopedic surgery, but the optimal route of iron intake is controversial. The aim of this study was to compare the clinical effects of erythropoietin in combination with oral or intravenous iron supplementation. METHODS: This study was a prospective, randomized, single-blinded, parallel arm trial. Patients scheduled for elective hip or knee arthroplasty with hemoglobin 10 to 13 g/dl received preoperative injections of erythropoietin with oral ferrous sulfate or intravenous ferric carboxymaltose. The primary endpoint was the hemoglobin value the day before surgery. RESULTS: One hundred patients were included in the analysis. The day before surgery, hemoglobin, increase in hemoglobin, and serum ferritin level were higher in the intravenous group. For the intravenous and oral groups, respectively, hemoglobin was as follows: median, 14.9 g/dl (interquartile range, 14.1 to 15.6) versus 13.9 g/dl (interquartile range, 13.2 to 15.1), group difference, 0.65 g/dl (95% CI, 0.1 to 1.2; P = 0.017); increase in hemoglobin: 2.6 g/dl (interquartile range, 2.1 to 3.2) versus 1.9 g/dl (interquartile range, 1.4 to 2.5), group difference, 0.7 g/dl (95% CI, 0.3 to 1.1; P \textless 0.001); serum ferritin: 325 \textmug/l (interquartile range, 217 to 476) versus 64.5 \textmug/l (interquartile range, 44 to 107), group difference, 257 \textmug/l (95% CI, 199 to 315; P \textless 0.001). The percentage of patients with nausea, diarrhea, or constipation was higher in the oral group, 52% versus 2%; group difference, 50% (95% CI, 35 to 64%; P \textless 0.0001). CONCLUSIONS: After preoperative administration of erythropoietin, body iron stores and stimulation of the erythropoiesis were greater with intravenous ferric carboxymaltose than with oral ferrous sulfate supplementation.

Dates et versions

hal-02317673 , version 1 (16-10-2019)

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Citer

Philippe Biboulet, Sophie Bringuier, Pierre Smilevitch, Thibault Loupec, Caroline Thuile, et al.. Preoperative Epoetin-α with Intravenous or Oral Iron for Major Orthopedic Surgery: A Randomized Controlled Trial. Anesthesiology, 2018, 129 (4), pp.710--720. ⟨10.1097/ALN.0000000000002376⟩. ⟨hal-02317673⟩
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