Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer

Abstract

Intravenous iron did not reduce the blood transfusion requirement but was more effective than oral iron at treating preoperative anaemia and iron deficiency in patients undergoing colorectal cancer surgery.

Randomised clinical trial: intravenous vs oral iron for the treatment of anaemia after acute gastrointestinal bleeding

“…The results of our study showing the superiority of FCM over oral FeSulf for the treatment and resolution of anaemia secondary to acute GIB is in line with evidence for the efficacy and safety of FCM in a wide range of conditions such as chronic kidney disease, colorectal cancer, inflammatory bowel disease, uterine bleeding and postpartum anaemia . The results are also consistent with a meta‐analysis that assessed studies using different iv iron preparation to treat IDA in patients with different conditions and concluded that although all iv and oral formulations could correct IDA, FCM was the superior treatment …”

Correcting preoperative iron deficiency as part of patient blood management in the ‘real world’: results of an audit on an Australian cohort

“…It is possible that PIT reduced RBCT by replenishing iron stores, thus, hastening recovery from perioperative blood loss . This is supported by the finding that although intravenous iron was more efficacious in improving preoperative haemoglobin than oral iron supplementation among patients undergoing surgery for colorectal cancer, there was no difference between the groups in terms of patients requiring RBCT or the amounts of red blood cells administered .…”

Cornerstones of patient blood management in surgery

“…Two recent surgical trials involving the use of IV iron to treat pre‐operative anaemia in patients undergoing colorectal and unspecified abdominal surgeries have shown conflicting responses in terms of transfusion outcomes (Froessler et al, ; Keeler et al, ). A trial by Froessler and his colleagues shows a significant reduction in RBC transfusion use by 60% in patients treated with IV iron pre‐operatively (Froessler et al, ).…”

“…A systematic review of patients with anaemia undergoing surgery (including orthopaedics, colorectal, gynaecology, spinal, cardiac, upper GI and head and neck) demonstrated an increase in the haemoglobin concentration and reduced to 0·88] with intravenous iron, especially when used with erythropoiesis-stimulating agents (ESAs) or in patients with lower ferritin concentration, without significant difference in mortality or severe adverse events (Lin et al, 2013). Two recent surgical trials involving the use of IV iron to treat pre-operative anaemia in patients undergoing colorectal and unspecified abdominal surgeries have shown conflicting responses in terms of transfusion outcomes (Froessler et al, 2016;Keeler et al, 2017). A trial by Froessler and his colleagues shows a significant reduction in RBC transfusion use by 60% in patients treated with IV iron pre-operatively (Froessler et al, 2016).…”

“…No difference was observed in secondary outcomes in terms of morbidity, mortality and quality of life, which is likely due to small sample size. A study by Keeler et al showed that IV iron that is more effective in increasing Hb compared to oral iron made no difference in terms of RBC transfusion use for colorectal surgery patients (Keeler et al, 2017). Both trials, small in population, have only identified primary outcomes in terms of RBC transfusion use, indicating the need for the continuation of larger ongoing trials and development of new studies investigating more insightful primary patient outcomes with a focus on functional performance and quality of life (Richards et al, 2015;Spahn, 2016;Bemelman, 2016).…”