Efectividad de distintas pautas de tratamiento de la anemia perioperatoria en pacientes ancianos con fractura de cadera

Abstract

The above mentioned blood saving programme has been observed to be effective in decreasing transfusional requirements without increasing morbidity. However, further prospective studies are needed in order to define the cost-effectiveness of this programme and to determine its role in the reduction of posttransfusional infections and postoperative length of stay.

Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single‐center randomized controlled trial

“…Cuenca and coworkers, 9,10 García‐Erce and coworkers, 12 and Izuel‐Rami and coworkers 14 report a significant decrease in infection rates in patients receiving IV iron therapy. These findings, however, were not confirmed either here or in more recent studies by Cuenca and coworkers, 11 Izuel‐Rami and coworkers, 13 and García‐Erce and coworkers, 15 in which urinary, respiratory, and surgical wound infection rates were similar in treated and untreated groups.…”

“…[4][5][6][7] Over the past 5 years, a number of studies have focused on the potential influence of IV iron therapy, either alone or combined with EPO, on transfusion requirements in patients undergoing surgery for hip fracture repair. [8][9][10][11][12][13][14][15] The authors conclude that, while iron therapy appears to be useful in certain types of patient, randomized controlled trials are required to confirm these findings.…”

Ferric carboxymaltose with or without erythropoietin for the prevention of red-cell transfusions in the perioperative period of osteoporotic hip fractures: a randomized contolled trial. The PAHFRAC-01 project

“…There are some retrospective studies showing positive results with the use of iron sucrose in preventing RCP transfusions in patients with HF [14-16]. The authors pointed out that, once injected in vivo, the iron-carbohydrate complexes are metabolized, the iron is released where it then binds transferrin in the plasma, and the redundant carbohydrate moiety is then cleared via the liver [30].…”

“…The most important factor in the development of anemia is blood loss, but some other mechanisms (renal failure, inflammation, iatrogenic hemodilution) are also implicated, prompting the choice of different therapeutic approaches [9,13,14]. These rely in three cornerstones: firstly minimizing blood loss in the operating room, secondly rationalizing RCP transfusion protocols, and thirdly enhancing bone-marrow red blood cell production [13-16].…”

“…These rely in three cornerstones: firstly minimizing blood loss in the operating room, secondly rationalizing RCP transfusion protocols, and thirdly enhancing bone-marrow red blood cell production [13-16]. Although evidence that this last measure saves RCP is weak, an increasing number of works have demonstrated notable reductions in RPC transfusion, nosocomial infections, hospital stay, and even survival [14-16]. Nevertheless, some biases in the nature of said studies could partly explain some of the obtained results.…”