title: The effectiveness and safety of preoperative use of erythropoietin in patients scheduled for total hip or knee arthroplasty: A systematic review and meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Because allogeneic blood transfusion carries a risk of serious complications, erythropoietin (EPO) has been used in patients scheduled for total hip or knee arthroplasty in an effort to reduce the need for allogeneic blood transfusion; however, its efficacy, cost-effectiveness, and safety are still controversial. The purpose of this review was to determine the hematopoiesis-promoting effect and potential complications, as well as the cost-effectiveness, of preoperative use of EPO in patients scheduled for total hip or knee arthroplasty.
  
  
  METHODS
  We searched MEDLINE, EMBASE, Cochrane, and ClinicalTrials.gov databases for relevant literature from 2000 to 2015. Risk of bias was assessed for all included studies and data were extracted and analyzed.
  
  
  RESULTS
  Preoperative use of EPO was associated with lower exposure to allogeneic blood transfusion (odds ratio = 0.41) and higher hemoglobin concentration after surgery (standardized mean difference = 0.86, P < 0.001). Complications were not generally reported, but there was no significant difference between the group with and without EPO based on given data. Cost-effectiveness was also summarized but was not conclusive.
  
  
  CONCLUSIONS
  Preoperative administration of EPO reduces the requirement for allogeneic blood transfusion and increases hemoglobin level after surgery. The studies of cost-effectiveness were not conclusive. Further studies and guidelines specific to blood management in the perioperative stage of total knee and hip arthroplasty are expected.
authors.affiliation: Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 1 Shuaifuyuan Wangfujing, Dongcheng District, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.forename: Chao
authors.initials: C
authors.lastname: Jiang
authors.forename: Huiming
authors.initials: H
authors.lastname: Peng
authors.forename: Bin
authors.initials: B
authors.lastname: Feng
authors.forename: Yulong
authors.initials: Y
authors.lastname: Li
authors.forename: Xisheng
authors.initials: X
authors.lastname: Weng
mesh_terms: D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D004921:Erythropoietin / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D011300:Preoperative Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: C554270:EPO protein, human; D004921:Erythropoietin