Does the Use of Erythropoietin Reduce the Risk of Exposure to Allogeneic Blood Transfusion in Cardiac Surgery? A Systematic Review and Meta-Analysis

Abstract

The administration of erythropoietin before cardiac surgery is associated with a significant reduction in the risk of exposure to allogeneic blood transfusion. Further studies are warranted to define the patients' subgroups that may benefit the most from EPO administration.

Assessment and treatment of preoperative anemia: Continuing Professional Development

“…10,49,[53][54][55][56] In these patient populations, ESAs have been shown to increase Hb levels, reduce allogeneic transfusion, increase aerobic capacity, and improve quality of life. 57 The ability of ESAs to reduce transfusions has been balanced by recent concerns of increased adverse outcomes (thrombosis, cancer progression) associated with ESA therapy in patients undergoing spine surgery and in patients with chronic renal failure and Sources: O'Brien et al 44 Vamvakas et al 43 RBC = red blood cells; HIV = human immunodeficiency virus; HCV = hepatitis C virus; HBV = hepatitis B virus; HTLV = Human T-cell leukemia/lymphoma virus; WNV = West Nile virus cancer.…”

“…In these patients, ESA therapy has been shown to reduce transfusions without a significant increase in the risk of thrombosis. 48,53,54 Given the potential for adverse events, a graded approach is suggested; ESAs are recommended for unresponsive iron deficiency anemia in which a component of anemia of chronic disease is suspected. 10 In addition, clinical studies suggest that brief and/or low-dose treatment of anemic perioperative patients with ESAs may be a safe and effective means of increasing red cell mass and avoiding red cell transfusion.…”

“…10,49,[53][54][55][56] Chez ces populations de patients, il a été démontré que les ESA augmentaient les taux de Hb, réduisaient les allotransfusions, augmentaient la capacité aérobique et amélioraient la qualité de vie. 57 La capacité des ESA à réduire les transfusions a été contrebalancée en raison d'inquiétudes récentes concernant une augmentation des pronostics défavorables (thrombose, progression du cancer) associés à un traitement à base d'ESA chez les patients subissant une chirurgie du rachis et chez les patients souffrant d'insuffisance rénale chronique et de cancer.…”

Estratégias para redução do uso de hemoderivados em cirurgia cardiovascular

“…The administration of erythropoietin two to three weeks prior to cardiac surgery is associated with a significant reduction in the need of hemotransfusion [7]. Erythropoietin has been used to increase packed red cell mass and its main side effect is increased systolic hypertension.…”

“…These strategies comprise the following: 1. The preoperative procedure, beginning with erythropoietin or iron administration weeks before cardiac surgery [7,8] and autologous blood collection before surgical procedure [9]; 2. Strategies adopted during the cardiac surgery, such as reduction in prime volume and the use of equipment such as hemoconcentrators [8], cell saver device [10,11] and Biopump [12], moderate hypothermia (30-32ºC) [8], reinfusion of all blood remaining in the CBP circuit [13], and the use of antifibrinolytics, such as aprotinin, tranexamic acid, and epsilon-aminocaproic acid [14][15][16][17][18][19][20][21][22][23][24], as well as reinfusion of the blood collected by mediastinal drainage in the first six hours postoperatively [13].…”