title: Combined erythropoietin and iron therapy for anaemic patients undergoing transcatheter aortic valve implantation: the EPICURE randomised clinical trial.
abstract: OBJECTIVE
  The aim of this study was to evaluate, in anaemic patients, the efficacy of erythropoietin (EPO) in reducing red cell (RC) transfusion rates post TAVI.
  
  
  RESULTS
  This was a randomised double-blind trial. Patients with severe symptomatic aortic stenosis and concomitant anaemia with an indication for TAVI were randomised (1:1) to receive two weight-based doses of EPO (darbepoetin alfa)+iron or placebo at days 10 (±4 days) and 1 (±1 day) pre TAVI. The primary outcome was the rate of RC transfusions at 30 days. A total of 100 patients (mean age 81±7 years, male 49%) were included: 48 patients received EPO (+iron) and 52 patients received placebo. Baseline characteristics and procedural findings were well balanced between groups except for baseline haemoglobin levels, which were lower in those patients receiving EPO (10.7±1.2 vs. 11.3±1.1 g/dl, p=0.01). The rate of 30-day RC transfusion was similar in both groups (27.1 vs. 25.0% in the EPO and placebo groups, respectively; adjusted odds ratio 1.05, 95% CI: 0.42-2.64, p=0.92), and no differences were observed in the number of RC units per transfused patient (1 [1-3] vs. 2 [1-2] in the EPO and placebo groups, respectively, adjusted p=0.99). Rates of 30-day mortality, stroke, new-onset atrial fibrillation, acute kidney injury, and troponin peak were also similar between groups (p>0.20 for all).
  
  
  CONCLUSIONS
  EPO (+iron) administration failed to reduce RC transfusion rates or the per-patient number of transfusion units in anaemic patients undergoing TAVI.
authors.affiliation: Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.forename: Maria
authors.initials: M
authors.lastname: Del Trigo
authors.forename: Omar Abdul-Jawad
authors.initials: OA
authors.lastname: Altisent
authors.forename: Francisco
authors.initials: F
authors.lastname: Campelo-Prada
authors.forename: Ander
authors.initials: A
authors.lastname: Regueiro
authors.forename: Robert
authors.initials: R
authors.lastname: DeLarochellière
authors.forename: Daniel
authors.initials: D
authors.lastname: Doyle
authors.forename: Siamak
authors.initials: S
authors.lastname: Mohammadi
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Paradis
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Eric
authors.initials: E
authors.lastname: Dumont
authors.forename: Rishi
authors.initials: R
authors.lastname: Puri
authors.forename: Vincent
authors.initials: V
authors.lastname: Laroche
authors.forename: Josep
authors.initials: J
authors.lastname: Rodés-Cabau
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000188:drug therapy*; D004311:Double-Blind Method; D017707:Erythrocyte Transfusion / Q000379:methods; D004921:Erythropoietin / Q000378:metabolism / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007501:Iron / Q000627:therapeutic use*; D008297:Male; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods
chemical_list: C554270:EPO protein, human; D004921:Erythropoietin; D007501:Iron