title: A single dose of erythropoietin reduces perioperative transfusions in cardiac surgery: results of a prospective single-blind randomized controlled trial.
abstract: BACKGROUND
  We conducted a prospective single-blind randomized study to assess whether a single 80,000 IU dose of human recombinant erythropoietin (HRE), given just 2 days before cardiac surgery, could be effective in reducing perioperative allogeneic red blood cell transfusion (aRBCt).
  
  
  METHODS
  Six-hundred patients presenting with preoperative hemoglobin (Hb) level of not more than 14.5 g/dL were randomly assigned to either HRE or control. The primary endpoint was the incidence of perioperative aRBCt. The secondary endpoints were mortality and the incidence of adverse events in the first 45 days after surgery, Hb level on Postoperative Day 4, and number of units of RBC transfusions in the first 4 days after surgery.
  
  
  RESULTS
  A total of 17% (HRE) versus 39% (control) required transfusion (relative risk, 0.436; p<0.0005). After baseline Hb was controlled for, there was no difference in the incidence of aRBCt between HRE (0%) and control (3.5%) among the patients with baseline Hb of 13.0 g/dL or more, which included the nonanemic fraction of the study population. The mean (range) Hb level on Postoperative Day 4 was 10.2 (9.9-10.6) g/dL (HRE) versus 8.7 (8.5-9.2) g/dL (control; p<0.0005). The distribution of number of units transfused was shifted toward fewer units in HRE (p<0.0005). The all-cause mortality at 45 days was 3.00% (HRE) versus 3.33% (control). The 45-day adverse event rate was 4.33% (HRE) versus 5.67% (control; both p=NS).
  
  
  CONCLUSIONS
  In anemic patients (Hb<13 g/dL), a single high dose of HRE administered 2 days before cardiac surgery is effective in reducing the incidence of aRBCt without increasing adverse events.
authors.affiliation: Cardiac Surgery Department, European Hospital.
authors.forename: Luca
authors.initials: L
authors.lastname: Weltert
authors.affiliation: Transfusion Medicine Department, San Camillo-Forlanini Hospital, Rome, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Rondinelli
authors.affiliation: Montefiore-Einstein Heart Center, Albert Einstein College of Medicine, Bronx, New York.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Bello
authors.affiliation: Anaesthesiology Department, European Hospital.
authors.forename: Mauro
authors.initials: M
authors.lastname: Falco
authors.affiliation: Cardiac Surgery Department, European Hospital.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bellisario
authors.affiliation: Cardiac Surgery Department, European Hospital.
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.affiliation: Anaesthesiology Department, European Hospital.
authors.forename: Franco
authors.initials: F
authors.lastname: Turani
authors.affiliation: Cardiac Surgery Department, European Hospital.
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.affiliation: Transfusion Medicine Department, San Camillo-Forlanini Hospital, Rome, Italy.|Department of Experimental Medicine, Sapienza University, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pierelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D004921:Erythropoietin / Q000008:administration & dosage*; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D019990:Perioperative Care / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality; D013997:Time Factors
chemical_list: D004921:Erythropoietin