Ferric Carboxymaltose for Anemic Perioperative Populations: A Systematic Literature Review of Randomized Controlled Trials

Abstract

Importance Perioperative anemia is a common comorbid condition associated with increased risk of morbidity and mortality in patients undergoing elective surgical procedures. Objective We conducted a systematic literature review (SLR) to determine the efficacy and safety of the use of intravenous ferric carboxymaltose (FCM) for the treatment of perioperative anemia in preoperative, intraoperative, and postoperative elective surgical care. Evidence Review Studies meeting inclusion criteria for the SLR reported on treatment efficacy in an adult study population randomly allocated to FCM for the treatment of perioperative anemia during the perioperative period. After screening, 10 of 181 identified studies from searches in MEDLINE and EMBASE databases were identified for inclusion in this review. Findings Preoperative treatment was reported in six studies, intraoperative treatment in one study, postoperative treatment in two studies, and both pre- and postoperative treatment in one study. Together, 1975 patients were studied, of whom 943 were randomized to FCM, of whom 914 received FCM treatment. The 10 studies reported elective surgical populations for colorectal, gastric, orthopedic, abdominal, urologic, plastic, neck, gynecologic, and otolaryngologic procedures. Given the clinical and methodological heterogeneity of the studies, the analyses were limited to qualitative assessments without meta-analyses. All 10 studies reported statistically greater changes in hemoglobin concentration, serum ferritin, and/or transferrin saturation with FCM treatment compared with comparators (placebo, oral iron, standard care, or a combination of these). Two studies reported statistically significant differences in transfusion rate and 2 studies reported significant differences in length of hospital stay between FCM and its comparator(s). Conclusions and Relevance This SLR adds to existing data that administration of FCM in preoperative and postoperative settings improves hematologic parameters. Several studies in the review supported the beneficial effects of FCM in reducing transfusion rate and length of stay. Larger, well-designed, longer-term studies may be needed to further establish the efficacy and safety of FCM in elective surgery patients with perioperative anemia.

Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram

“…Dominique Engel predicted perioperative blood transfusion in patients undergoing surgery using the same nomogram and exhibited that preoperative HGB was a vital factor affecting blood transfusion [ 8 ]. The preoperative low HGB may be closely related to the deficiency of iron, vitamin B12, and folic acid [ 11 , 12 ].…”

“…The delay in surgery due to inadequate preoperative blood preparation is deleterious for patients. The requirement for blood transfusion in spinal tuberculosis surgery depends on several factors such as anaemia caused due to a deficiency of iron [ 11 ], vitamin B12, and folic acid [ 12 ], which are used to compound haemoglobin (HGB) and sex of the patient [ 13 – 15 ]. Dong et al exhibited that the factors such as preoperative mean corpuscular haemoglobin concentration, surgical duration, preoperative HGB, intraoperative blood loss, number of fused vertebrae, and anticoagulant history can predict the risk of blood transfusion after spinal tuberculosis fusion [ 16 ].…”

Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study

“…This further emphasizes the importance of a solid preparation of patients by implementing standardized patient blood management concepts prior to cystectomy. Preoperative anemia should be corrected accordingly, through intravenous administration of an iron formulation, which results in a more rapid response compared to the oral formulation [31,32]. In addition, vitamin B12 and folic acid are also recommended for intravenous iron administration [33].…”

Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A 2022 Update

“…Six SRs [16][17][18][19][20][21] including 3 with meta-analysis (MA), 16,17,19 4 RCTs, [22][23][24][25] 6 non-randomized studies, [26][27][28][29][30][31] and 1 evidence-based guideline 32 was included in this report.…”

“…Four SRs [16][17][18]20 had broader inclusion criteria than this report: 3 SRs 16-18 including 2 with MA 16,17 included a range of interventions related to iron supplementation including the use of oral iron supplementation. One SR included a study with an irrelevant comparator.…”