Erythropoietin to reduce allogeneic red blood cell transfusion in patients undergoing total hip or knee arthroplasty.
OBJECTIVE
To determine the value of erythropoietin in reducing allogeneic transfusions, it is important to assess the effects, safety and costs for individual indications. Previous studies neither compared the effects of erythropoietin between total hip and total knee arthroplasty, nor evaluated the safety or costs. We performed a meta-analysis to assess the effects of erythropoietin in total hip and knee arthroplasty separately. Safety and costs were evaluated as secondary outcomes.


METHODS
A systematic literature search was performed to identify randomized controlled trials evaluating the effect of erythropoietin in total hip and knee arthroplasty until April 2014. Study data were extracted using standardized forms and pooled using a random-effects model. Strength of the evidence was evaluated using Cochrane's Collaboration's tool for risk of bias assessment.


RESULTS
Seven studies were included (2439 patients). Erythropoietin significantly reduced exposure to allogeneic transfusion in both hip (RR 0·45; 95%CI 0·33-0·61) and knee (RR 0·38; 95%CI 0·27-0·53) arthroplasty, without differences between indications (P = 0·44). Mean number of transfused red blood cell units was significantly decreased in erythropoietin-treated patients (mean difference -0·57; 95%CI -0·86 to -0·29)(unable to split). No differences in thromboembolic or adverse events were found. Only one study evaluated costs, so that no pooled cost-effectiveness estimates could be given.


CONCLUSIONS
Erythropoietin is effective in both hip and knee arthroplasty and can be considered as safe. However, the decision to use erythropoietin on a routine base should be balanced against its costs, which may be relatively high.
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
V M A
VM
Voorn
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
A
A
van der Hout
Department of Transfusion Medicine and Centre for Clinical Transfusion Research, Sanquin Blood Supply Foundation, Leiden, The Netherlands.|Department of Internal Medicine, Groene Hart Hospital, Gouda, The Netherlands.
C
C
So-Osman
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
T P M
TP
Vliet Vlieland
Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.
R G H H
RG
Nelissen
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
M E
ME
van den Akker-van Marle
Department of Anaesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
A
A
Dahan
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
P J
PJ
Marang-van de Mheen
Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands. l.vanbodegom-vos@lumc.nl.
L
L
van Bodegom-Vos
D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D002986:Clinical Trials as Topic; D017707:Erythrocyte Transfusion; D004912:Erythrocytes / Q000166:cytology / Q000187:drug effects / Q000378:metabolism; D004921:Erythropoietin / Q000008:administration & dosage* / Q000494:pharmacology; D006801:Humans; D014184:Transplantation, Homologous; D020246:Venous Thrombosis / Q000517:prevention & control
D004921:Erythropoietin
allogeneic red blood cell transfusion; erythropoietin; hip arthroplasty; knee arthroplasty; meta-analysis; patient blood management