Newly Published
Perioperative Medicine  |   August 2018
Preoperative Epoetin-α with Intravenous or Oral Iron for Major Orthopedic Surgery: A Randomized Controlled Trial
Author Notes
  • From the Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, CHU Montpellier, University of Montpellier, Montpellier, France (P.B., P.S., T.L., C.T., M.P., G.M., G.D., X.C.); Department of Medical Statistics, CHU Montpellier, University of Montpellier, Montpellier, France (S.B.); and Inserm Unit 1051 Montpellier NeuroSciences Institute, University of Montpellier, Montpellier, France (X.C.).
  • Part of this work was presented as the Cross Iron study, winner of the best abstract in anesthesia at the annual meeting of the French Society of Anesthesiology and Critical Care Medicine (Société Française d'Anesthésie et de Réanimation Congress), in Paris, France, September 21, 2017.
    Part of this work was presented as the Cross Iron study, winner of the best abstract in anesthesia at the annual meeting of the French Society of Anesthesiology and Critical Care Medicine (Société Française d'Anesthésie et de Réanimation Congress), in Paris, France, September 21, 2017.×
  • Submitted for publication January 31, 2018. Accepted for publication June 21, 2018.
    Submitted for publication January 31, 2018. Accepted for publication June 21, 2018.×
  • Acknowledgments: The authors thank Nicolas Molinari, Ph.D. (Department of Medical Information, Hôpital de la Colombière University Hospital, Montpellier, France), for his statistical assistance; Nadia Rosencher, M.D. (Department of Anesthesiology and Critical Care Medicine, Cochin – Hôtel Dieu University Hospital, Paris, France), for her scientific guidance; Aboud Jabari, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France), and Oliver Karam, M.D., Ph.D. (Children’s Hospital of Richmond, Richmond, Virginia), for their help with the translation and composition of article; and Julie Villard, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Nathalie Bernard, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Michèle Kassim, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Didier Morau, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Bertrand Abbal, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), and Jean François Adam, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), for their enrollment of patients.
    Acknowledgments: The authors thank Nicolas Molinari, Ph.D. (Department of Medical Information, Hôpital de la Colombière University Hospital, Montpellier, France), for his statistical assistance; Nadia Rosencher, M.D. (Department of Anesthesiology and Critical Care Medicine, Cochin – Hôtel Dieu University Hospital, Paris, France), for her scientific guidance; Aboud Jabari, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Montpellier, France), and Oliver Karam, M.D., Ph.D. (Children’s Hospital of Richmond, Richmond, Virginia), for their help with the translation and composition of article; and Julie Villard, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Nathalie Bernard, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Michèle Kassim, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Didier Morau, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), Bertrand Abbal, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), and Jean François Adam, M.D. (Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital), for their enrollment of patients.×
  • Research Support: Support was provided solely from institutional and/or departmental sources.
    Research Support: Support was provided solely from institutional and/or departmental sources.×
  • Competing Interests: The authors declare no competing interests.
    Competing Interests: The authors declare no competing interests.×
  • Reproducible Science: Full protocol available from Dr. Biboulet: p-biboulet@chu-montpellier.fr. Raw data available from Dr. Biboulet: p-biboulet@chu-montpellier.fr.
    Reproducible Science: Full protocol available from Dr. Biboulet: p-biboulet@chu-montpellier.fr. Raw data available from Dr. Biboulet: p-biboulet@chu-montpellier.fr.×
  • Correspondence: Address correspondence to Dr. Biboulet: Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, 34295 Montpellier Cedex 5, France. p-biboulet@chu-montpellier.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Hematologic System
Perioperative Medicine   |   August 2018
Preoperative Epoetin-α with Intravenous or Oral Iron for Major Orthopedic Surgery: A Randomized Controlled Trial
Anesthesiology Newly Published on August 2, 2018. doi:10.1097/ALN.0000000000002376
Anesthesiology Newly Published on August 2, 2018. doi:10.1097/ALN.0000000000002376
Abstract

What We Already Know about This Topic:

  • Epoetin-α is often given to patients scheduled for major orthopedic surgery

  • It remains unknown whether it is best to accompany epoetin-α with oral or intravenous iron

What This Article Tells Us That Is New:

  • Hemoglobin level the day before surgery was 1 g/dl greater in 50 patients randomized to intravenous iron than in those assigned to oral iron

  • About half the patients given oral iron reported gastrointestinal symptoms

  • Intravenous iron is preferable to oral iron as a supplement to epoetin-α

Background: Preoperative administration of epoetin-α with iron is commonly used in anemic patients undergoing major orthopedic surgery, but the optimal route of iron intake is controversial. The aim of this study was to compare the clinical effects of erythropoietin in combination with oral or intravenous iron supplementation.

Methods: This study was a prospective, randomized, single-blinded, parallel arm trial. Patients scheduled for elective hip or knee arthroplasty with hemoglobin 10 to 13 g/dl received preoperative injections of erythropoietin with oral ferrous sulfate or intravenous ferric carboxymaltose. The primary endpoint was the hemoglobin value the day before surgery.

Results: One hundred patients were included in the analysis. The day before surgery, hemoglobin, increase in hemoglobin, and serum ferritin level were higher in the intravenous group. For the intravenous and oral groups, respectively, hemoglobin was as follows: median, 14.9 g/dl (interquartile range, 14.1 to 15.6) versus 13.9 g/dl (interquartile range, 13.2 to 15.1), group difference, 0.65 g/dl (95% CI, 0.1 to 1.2; P = 0.017); increase in hemoglobin: 2.6 g/dl (interquartile range, 2.1 to 3.2) versus 1.9 g/dl (interquartile range, 1.4 to 2.5), group difference, 0.7 g/dl (95% CI, 0.3 to 1.1; P < 0.001); serum ferritin: 325 µg/l (interquartile range, 217 to 476) versus 64.5 µg/l (interquartile range, 44 to 107), group difference, 257 µg/l (95% CI, 199 to 315; P < 0.001). The percentage of patients with nausea, diarrhea, or constipation was higher in the oral group, 52% versus 2%; group difference, 50% (95% CI, 35 to 64%; P < 0.0001).

Conclusions: After preoperative administration of erythropoietin, body iron stores and stimulation of the erythropoiesis were greater with intravenous ferric carboxymaltose than with oral ferrous sulfate supplementation.