Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia

Khouly, Nabih I El

doi:10.1080/14767058.2016.1192602

Cited by 13 publications

(23 citation statements)

References 18 publications

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“…Fifteen randomized trials met our inclusion criteria. [18][19][20][21][22][32][33][34][35][36][37][38][39][40][41] Reasons for excluding the remaining 17 studies are described in Appendix 2. Our study cohort comprised 2182 women, with 1001 and 1181 women receiving oral iron and IV iron therapy, respectively.…”

Section: Data Synthesismentioning

confidence: 99%

“…21 Fourteen trials consisted of 2 treatment arms (oral and IV iron). One study had 3 treatments arms 22 ; 2 arms comprised IV iron preparations (ferrous sucrose and ferrous carboxymaltose, respectively), and 1 arm comprised oral Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart for studies identified and excluded (included studies [18][19][20][21][22][32][33][34][35][36][37][38][39][40][41] 22 Two studies included women with other comorbid disease. 22,40 One study excluded women with known nutritional disorders.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Since the publication of that review, 4 new randomized trials have been published comparing IV iron to oral iron therapy. [19][20][21][22] Because the findings of newly identified studies can potentially change the conclusions of previous systematic reviews, 23 a comprehensive evaluation of clinical and hematologic data may result in important changes to clinical guidelines and clinical protocols for postpartum anemia management. Therefore, we performed an updated systematic review of all randomized trials comparing oral vs IV iron therapy to treat postpartum anemia, with postpartum hemoglobin as the primary outcome measure.…”

Section: Introductionmentioning

confidence: 99%

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Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis

Sultan

Bampoe

Shah

et al. 2019

American Journal of Obstetrics and Gynecology

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To perform a systematic review of randomized trials comparing oral vs intravenous (IV) iron therapy to treat postpartum anemia. DATA SOURCES: Data sources were as follows: PubMed (1972e2017); Cochrane Central Register of Controlled Trials, CENTRAL (1972e2017); CINAHL (1972e2017); Web of Science; Excerpta Medica Database, and EMBASE (1972e2017). STUDY ELIGIBILITY CRITERIA: We included randomized trials comparing oral vs IV iron monotherapy to treat postpartum anemia (classified as a hemoglobin <12 g/dL). STUDY APPRAISAL AND SYNTHESIS METHODS: Study quality was assessed with the Cochrane risk of bias assessment tool. The primary outcome was hemoglobin concentration at 6 weeks postpartum. Secondary outcomes included hemoglobin concentration at 1À5 weeks postpartum, ferritin concentration at 1À6 weeks postpartum, and maternal adverse outcomes. For meta-analysis, mean differences and odds ratios using a random effects model were calculated. Risk of heterogeneity was reported as I 2. RESULTS: A total of 15 randomized trials met our inclusion criteria (n ¼ 1001 and 1 181 women receiving oral iron and IV iron, respectively); 4 studies reported data for our primary outcome. We observed higher postpartum week 6 hemoglobin concentrations in the IV iron group compared to the oral iron group (mean difference, 0.9 g/dL; 95% confidence interval (CI), 0.4À1.3; P ¼ .0003). Compared to oral iron, women receiving IV iron had higher hemoglobin concentrations at postpartum weeks 1, 2, and 3; higher ferritin concentrations at postpartum weeks 1, 2, 4, and 6; an increased likelihood of skin flushing (odds ratio [OR], 6.95; 95% CI, 1.56À31.03; P ¼ .01; I 2 ¼ 0%); and a decreased likelihood of constipation (OR, 0.08; 95% CI, 0.03À0.21; P < .00001, I 2 ¼ 27%) and dyspepsia (OR, 0.07; 95% confidence interval, 0.01À0.42; P ¼ .004; I 2 ¼ 0%). The reported event rate for anaphylaxis among women receiving IV iron was 0.6%. CONCLUSION: In this systematic review, among women with postpartum anemia, hemoglobin concentrations at 6 weeks postpartum were almost 1 g/dL higher in women who received IV iron compared to oral iron. The safety profile of IV iron was also reassuring. Given the weaker hemoglobin response and higher risk of gastrointestinal side effects with oral iron use, our findings suggest that IV iron be considered as a viable treatment option for postpartum iron deficiency anemia.

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Section: Data Synthesismentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis

Sultan

Bampoe

Shah

et al. 2019

American Journal of Obstetrics and Gynecology

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“…Two of these studies have shown significant improvement in hemoglobin levels on posttreatment day 14 from intravenous iron, but these differences were modest. In absolute terms, there was a smaller increase in hemoglobin of 1.4-1.5 g/dL in those receiving oral iron as compared with 2.0-3.8 g/dL in those receiving intravenous iron (109,111). At posttreatment day 40-42 none of the studies demonstrated a difference in hemoglobin level or any other clinical outcomes between oral or intravenous iron.…”

Section: Cell Salvagementioning

confidence: 97%

“…When a blood transfusion is not necessary, but supplemental iron is indicated, the use of intravenous iron (ferrous sucrose) has been compared to oral iron for postpartum anemia in a few small randomized controlled trials. (109)(110)(111)(112). Two of these studies have shown significant improvement in hemoglobin levels on posttreatment day 14 from intravenous iron, but these differences were modest.…”

Section: Cell Salvagementioning

confidence: 99%

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

Fahrenholtz

Bonanno²,

Martin

2019

JBI Database of Systematic Reviews and Implementation Reports

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Maternal hemorrhage, defined as a cumulative blood loss of greater than or equal to 1,000 mL or blood loss accompanied by signs or symptoms of hypovolemia within 24 hours after the birth process, remains the leading cause of maternal mortality worldwide (1). Additional important secondary sequelae from hemorrhage exist and include adult respiratory distress syndrome, shock, disseminated intravascular coagulation, acute renal failure, loss of fertility, and pituitary necrosis (Sheehan syndrome).Hemorrhage that leads to blood transfusion is the leading cause of severe maternal morbidity in the United States closely followed by disseminated intravascular coagulation (2). In the United States, the rate of postpartum hemorrhage increased 26% between 1994 and 2006 primarily because of increased rates of atony (3). In contrast, maternal mortality from postpartum obstetric hemorrhage has decreased since the late 1980s and accounted for slightly more than 10% of maternal mortalities (approximately 1.7 deaths per 100,000 live births) in 2009 (2, 4). This observed decrease in mortality is associated with increasing rates of transfusion and peripartum hysterectomy (2)(3)(4).The purpose of this Practice Bulletin is to discuss the risk factors for postpartum hemorrhage as well as its evaluation, prevention, and management. In addition, this document will encourage obstetrician-gynecologists and other obstetric care providers to play key roles in implementing standardized bundles of care (eg, policies, guidelines, and algorithms) for the management of postpartum hemorrhage.

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Risk of Infection Associated With Administration of Intravenous Iron

et al. 2021

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IMPORTANCEIntravenous iron is recommended by many clinical guidelines based largely on its effectiveness in reducing anemia. However, the association with important safety outcomes, such as infection, remains uncertain. OBJECTIVE To examine the risk of infection associated with intravenous iron compared with oral iron or no iron. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for randomized clinical trials (RCTs) from 1966 to January 31, 2021. Ongoing trials were sought from ClinicalTrials.gov, CENTRAL, and the World Health Organization International Clinical Trials Search Registry Platform. STUDY SELECTION Pairs of reviewers identified RCTs that compared intravenous iron with oral iron or no iron across all patient populations, excluding healthy volunteers. Nonrandomized studies published since January 1, 2007, were also included. A total of 312 full-text articles were assessed for eligibility. DATA EXTRACTION AND SYNTHESIS Data extraction and risk of bias assessments were performed according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) and Cochrane recommendations, and the quality of evidence was assessed using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) approach. Two reviewers extracted data independently. A random-effects model was used to synthesize data from RCTs. A narrative synthesis was performed to characterize the reporting of infection. MAIN OUTCOMES AND MEASURESThe primary outcome was risk of infection. Secondary outcomes included mortality, hospital length of stay, and changes in hemoglobin and red blood cell transfusion requirements. Measures of association were reported as risk ratios (RRs) or mean differences.RESULTS A total of 154 RCTs (32 920 participants) were included in the main analysis. Intravenous iron was associated with an increased risk of infection when compared with oral iron or no iron (RR, 1.17; 95% CI, 1.04-1.31; I 2 = 37%; moderate certainty of evidence). Intravenous iron also was associated with an increase in hemoglobin (mean difference, 0.57 g/dL; 95% CI, 0.50-0.64 g/dL; I 2 = 94%) and a reduction in the risk of requiring a red blood cell transfusion (RR, 0.93; 95% CI, 0.76-0.89; I 2 = 15%) when compared with oral iron or no iron. There was no evidence of an effect on mortality or hospital length of stay. (continued) Key Points Question In patients who require treatment with intravenous iron, what is the evidence that this intervention increases the risk of developing a new infection? Findings In this systematic review and meta-analysis of 154 randomized clinical trials that included 32 920 participants, intravenous iron was associated with an increased risk of infection. Meaning The results of this study suggest that, despite broad advocacy in clinical guidelines, intravenous iron may increase the risk of infection, which must be balanced with the potential benefits of treating anemia and reducing blood transfusion requirements.

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Comparison of intravenous ferrous sucrose and oral ferrous sulphate in treatment of postpartum iron deficiency anemia

Abstract: Intravenous ferrous sucrose increases Hb level more rapidly than ferrous sulphate in women with postpartum IDA. It also replenishes iron stores more rapidly with better tolerability.

Cited by 13 publications

References 18 publications

Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis

Oral vs intravenous iron therapy for postpartum anemia: a systematic review and meta-analysis

Tranexamic acid as adjuvant treatment for postpartum hemorrhage: a systematic review protocol

Risk of Infection Associated With Administration of Intravenous Iron

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