Effectiveness and safety of erythropoiesis-stimulating agent use in the perioperative period.
BACKGROUND
Erythropoiesis-stimulating agents (ESAs) are widely used in treating anemia associated with renal failure. They are also now used perioperatively to reduce the use of allogeneic blood transfusions (ABTs) in patients undergoing surgery with anticipated high blood loss. Although they can reduce the risks associated with ABT and improve quality of life, the use of ESAs is still associated with adverse effects.


METHODS
A narrative review is provided on ESAs and a systematic review has been conducted to examine the current evidence for the efficacy and safety of perioperative ESAs use. A search of PubMed and Medline databases has been performed using a combination of search terms including erythropoietin, perioperative, surgical, safety and efficacy.


CONCLUSIONS
Current evidence supports the use of perioperative ESAs to reduce the need for ABT. However, large studies assessing safety in anemic patients with chronic renal disease have found adverse effects including cardiovascular, stroke and thromboembolic events. However, whether these concerns can be conferred onto the surgical population remains to be seen as the perioperative dosing strategies have been more variable in timing, dose and duration in comparison with those used for chronic diseases. Future research needs to address the questions of optimal dosing strategies in order to maximize the positive effects and minimize adverse events.
University of Hong Kong, Queen Mary Hospital, Department of Anaesthesiology , 102 Pokfulam Road, HK , Hong Kong gordon@hku.hk.
Diane H D
DH
Tran
Gordon T C
GT
Wong
Yee Eot
YE
Chee
Michael G
MG
Irwin
D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D004334:Drug Administration Schedule; D004920:Erythropoiesis / Q000187:drug effects*; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D006397:Hematinics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D019990:Perioperative Care; D019106:Postoperative Hemorrhage / Q000097:blood / Q000517:prevention & control; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
C554270:EPO protein, human; D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin