Evaluating Preoperative Intravenous Iron and Erythropoietin Treatment and Outcomes in Cardiac Surgery Patients

Abstract

Background: Anemia is more common in cardiac surgery patients than in other people. Severe anemia before cardiac surgery strongly predicts blood transfusion. Objectives: This study aimed to evaluate the outcomes of Intravenous (IV) iron and erythropoietin (EPO) injection preoperatively in anemic patients waiting for coronary artery bypass graft (CABG) surgery. Methods: This cross-sectional study was performed between May to December 2020 at Masih Daneshvari hospital in Tehran, Iran. Anemia was described according to the WHO definition (Hb < 130 g/L in men). The study was designed in two groups of men CABG patients. Hematocrit level, platelet count, partial thromboplastin time, international normalized ratio, prothrombin time before surgery, red blood cells (RBCs) transfusion, as well as plasma and platelet units’ transfusion during surgery and at the time of hospitalization were obtained from patient’s files. The length of stay in the hospital and the consequences, including infection, stroke and heart attack, and mortality, were also obtained from the patient's files and recorded in the checklists. Pearson’s chi-squared test, Fisher’s exact test, independent samples t-test, univariate logistic regression, and odds ratio (OR) were used. All statistical analyses were performed by the SPSS software version 21. The significance level in this study was considered 0.05. Results: In this study, the data of 64 patients were gathered, among whom 16 (25%) were injected with IV iron and EPO, and the remaining 48 (75%) did not receive any medications for stimulating erythropoiesis. The mean age of patients was 64.05 ± 8.21 years, with an age range of 51 - 91 years. Infection (P = 0.258) and mortality rate (P = 0.440) in the two groups of injection and non-injection did not show a statistically significant difference. The duration of the clamp at the time of surgery (r = 0.699, P = 0.001) and the duration of hospitalization (r = 0.399, P = 0.023) had statistically significant positive relationships with the pump duration. Red blood cell consumption in the injection and non-injection groups was 2.50 ± 2.07 and 2.90 ± 1.80 (P = 0.469), respectively. Conclusions: Infection (P = 0.258), mortality rate (P = 0.440), and RBC utilization (P = 0.469) in the two groups of injection and non-injection were not significantly different.