Pre‐operative optimisation with intravenous iron in cardiac surgery: a reply

Quarterman, Clare; Agarwal, Seema

doi:10.1111/anae.15448

Cited by 3 publications

(4 citation statements)

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“…However, their meta-analysis [ 13 , 31 ] included studies exploring the efficacy of IV iron in nonanemic patients. Nonanemic patients were less likely to receive blood transfusion than anemic patients [ 32 , 33 ], resulting in overall transfusion rates in these studies [ 13 , 31 ] decreasing. However, this positive change may be caused by participants’ characteristics or IV iron therapy, and thus the benefits of IV iron on reducing the transfusion requirement for patients with anemia may be obfuscated.…”

Section: Discussionmentioning

confidence: 99%

“…Taken together, future studies with a sufficiently large sample size are needed to focus on patients undergoing cardiac surgery. Further data are also required to examine the role of IV iron in three aspects: [ 1 ] applying IV iron with or without other agents (mainly EPO); [ 2 ] dosage of IV iron; and [ 3 ] time of IV iron administration preoperatively [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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The efficacy of intravenous iron for treatment of anemia before cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis

Tang

et al. 2023

J Cardiothorac Surg

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Background Preoperative anemia is common in patients undergoing cardiac surgery with various etiologies, among which iron deficiency is the leading cause. However, the benefit of intravenous (IV) iron for the treatment of anemia before cardiac surgery is uncertain. This updated meta-analysis aimed to evaluate the efficacy of IV iron in adult cardiac surgery patients with preoperative anemia. Methods This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched Embase, PubMed and the Cochrane Central Register of Controlled Trials to identify eligible randomized controlled trials (RCTs) and observational studies. Quality was assessed using the Cochrane Collaboration risk of bias tool and Newcastle–Ottawa scale, and the strength of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. Trial sequential analysis was performed on the primary outcome (transfusion rate) to confirm whether firm evidence was reached. Results Six RCTs (936 patients) and 5 observational studies (1350 patients) were included in this meta-analysis. The IV iron group and the control group were comparable in terms of transfusion rate [55.1% vs 60.9%, risk ratio (RR) = 0.91, 95% confidence interval (CI) 0.81–1.03, P = 0.13, low quality]. There were no significant differences in units transfused per patient, ICU stay and hospital length of stay between the two groups. And pooled data showed a benefit of IV iron compared to the control group on mortality (2.76% vs 3.75%, RR = 0.58, 95% CI 0.36–0.95, P = 0.03, moderate quality) and no mortality reduction existed when including only RCTs. Conclusions This meta-analysis suggested that IV iron treatment for patients with anemia before cardiac surgery did not reduce the transfusion requirement (low quality), but it was associated with decreased mortality (moderate quality). More large-scale, high-quality randomized clinical trials are warranted to confirm or refute our findings. PROSPERO registry reference: CRD42022331875.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The efficacy of intravenous iron for treatment of anemia before cardiac surgery: An updated systematic review and meta-analysis with trial sequential analysis

Tang

et al. 2023

J Cardiothorac Surg

View full text Add to dashboard Cite

show abstract

“…The work undertaken by Evans, Quarterman and Richards generates more questions for future research rather than answering the question -does pre-operative intravenous iron reduce the need for blood transfusion in elective surgery? In Evans' and Quarterman's studies, for those patients who achieved non-anaemic status by the time of surgery, intravenous iron was effective at reducing transfusion requirement, but likely the truly iron deficient patients achieved the best response [30,31,34].…”

Section: Discussionmentioning

confidence: 99%

“…In response to a letter [33], Quarterman et al presented a subgroup analysis on the treated anaemic patients who were non-anaemic by the time of surgery and those who remained anaemic [34]. Of the one hundred and ninety patients treated, 74 (38.9%) patients achieved non-anaemic status by surgery.…”

Section: Quarterman Et Al Pathwaymentioning

confidence: 99%