The Effect of Orally and Parenterally Administered Iron in Posthaemorrhagic Anaemia
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Cited by 3 publications
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AimsAnaemia is increasingly recognised as having an independent impact upon patient outcomes in cardiac disease. The role of novel iron therapies to treat anaemia is increasing. This systematic review and meta-analysis assesses the efficacy and safety of iron therapies for the treatment of adults with anaemia. Methods and ResultsElectronic databases and search engines were searched as per Cochrane methodology. Randomised controlled trials (RCTs) of iron versus inactive control or placebo, as well as alternative formulations, doses and routes in anaemic adults without chronic kidney disease or in the peri-partum period were eligible. The primary outcome of interest was mortality at one year.Secondary outcomes were blood transfusion, haemoglobin levels, quality of life, serious adverse events and length of hospital stay. 64 RCTs (including five studies of heart failure patients) including 9004 participants were included. None of the studies were at a low risk of bias. There were no statistically significant differences in mortality between iron and inactive control. Both oral and parenteral iron significantly reduced the proportion of patients requiring blood transfusion compared to inactive control (risk ratio (RR) 0.66 (95% confidence interval (CI) 0.48 to 0.90) and RR 0.84 (95% CI 0.73 -0.97) respectively. Haemoglobin was increased more by both oral and parenteral iron compared to inactive control (mean difference (MD) 0.91 g/dL (95% CI 0.48 to 1.35) and MD 1.04 (95% CI 0.52 to 1.57) respectively), and Iron for Anaemic Adults 3 parenteral iron demonstrated a greater increase when compared to oral iron (MD 0.53 g/dL (95% CI 0.31 to 0.75)). In all comparisons there were no differences in the results comparing patients with and without heart failure. ConclusionBoth oral and parenteral iron are shown to decrease the proportion of people who require blood transfusion and increase haemoglobin levels, without any benefit in mortality. Further trials at a low risk of bias, powered to measure clinically significant endpoints are still required. * This paper updates the findings of a Cochrane review first published December 2014 in The Cochrane Database of Systematic Reviews (CDSR) Issue 12 (http://www.thecochranelibrary.com).
AimsAnaemia is increasingly recognised as having an independent impact upon patient outcomes in cardiac disease. The role of novel iron therapies to treat anaemia is increasing. This systematic review and meta-analysis assesses the efficacy and safety of iron therapies for the treatment of adults with anaemia. Methods and ResultsElectronic databases and search engines were searched as per Cochrane methodology. Randomised controlled trials (RCTs) of iron versus inactive control or placebo, as well as alternative formulations, doses and routes in anaemic adults without chronic kidney disease or in the peri-partum period were eligible. The primary outcome of interest was mortality at one year.Secondary outcomes were blood transfusion, haemoglobin levels, quality of life, serious adverse events and length of hospital stay. 64 RCTs (including five studies of heart failure patients) including 9004 participants were included. None of the studies were at a low risk of bias. There were no statistically significant differences in mortality between iron and inactive control. Both oral and parenteral iron significantly reduced the proportion of patients requiring blood transfusion compared to inactive control (risk ratio (RR) 0.66 (95% confidence interval (CI) 0.48 to 0.90) and RR 0.84 (95% CI 0.73 -0.97) respectively. Haemoglobin was increased more by both oral and parenteral iron compared to inactive control (mean difference (MD) 0.91 g/dL (95% CI 0.48 to 1.35) and MD 1.04 (95% CI 0.52 to 1.57) respectively), and Iron for Anaemic Adults 3 parenteral iron demonstrated a greater increase when compared to oral iron (MD 0.53 g/dL (95% CI 0.31 to 0.75)). In all comparisons there were no differences in the results comparing patients with and without heart failure. ConclusionBoth oral and parenteral iron are shown to decrease the proportion of people who require blood transfusion and increase haemoglobin levels, without any benefit in mortality. Further trials at a low risk of bias, powered to measure clinically significant endpoints are still required. * This paper updates the findings of a Cochrane review first published December 2014 in The Cochrane Database of Systematic Reviews (CDSR) Issue 12 (http://www.thecochranelibrary.com).
Anaemia is increasingly recognized as having an independent impact upon patient outcomes in cardiac disease. The role of novel iron therapies to treat anaemia is increasing. This systematic review and meta-analysis assesses the efficacy and safety of iron therapies for the treatment of adults with anaemia. Electronic databases and search engines were searched as per Cochrane methodology. Randomized controlled trials (RCTs) of iron vs. inactive control or placebo, as well as alternative formulations, doses, and routes in anaemic adults without chronic kidney disease or in the peri-partum period were eligible. The primary outcome of interest was mortality at 1 year. Secondary outcomes were blood transfusion, haemoglobin levels, quality of life, serious adverse events, and length of hospital stay. A total of 64 RCTs (including five studies of heart failure patients) comprising 9004 participants were included. None of the studies was at a low risk of bias. There were no statistically significant differences in mortality between iron and inactive control. Both oral and parenteral iron significantly reduced the proportion of patients requiring blood transfusion compared with inactive control [risk ratio (RR) 0.66, 95% confidence interval (CI) 0.48-0.90; and RR 0.84, 95% CI 0.73-0.97, respectively]. Haemoglobin was increased more by both oral and parenteral iron compared with inactive control [mean difference (MD) 0.91 g/dL, 95% CI 0.48 to 1.35; and MD 1.04, 95% CI 0.52 to 1.57, respectively], and parenteral iron demonstrated a greater increase when compared with oral iron (MD 0.53 g/dL, 95% CI 0.31-0.75). In all comparisons, there were no differences in the results comparing patients with and without heart failure. Both oral and parenteral iron are shown to decrease the proportion of people who require blood transfusion and increase haemoglobin levels, without any benefit on mortality.
SummaryPre‐operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri‐operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non‐cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre‐operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of ‘functional’ iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre‐operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.
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