New systematic review on the safety of preoperative iron and EPO administration in elective surgery patients with anemia


During the 2018 International Consensus Conference on Patient Blood Management, a set of evidence-based treatment and research recommendations were formulated. Preoperative iron supplementation and erythropoiesis-stimulating agent (ESA) administration were recommended to reduce red blood cell transfusion rates in adult patients with anemia undergoing scheduled surgery. However, little is known about the safety of these therapies. Therefore, this systematic review investigated the occurrence of adverse events during or after treatment with iron and/or ESAs.

Data from 26 randomized controlled trials and 16 cohort studies on 6 treatment comparisons across 15 adverse event categories were extracted. Most data concerned mortality/survival, thromboembolic, infectious, cardiovascular and gastrointestinal adverse events.
Very low certainty evidence was assigned to all but one outcome category, meaning that it remains unclear if ESA and/or iron therapy is associated with adverse events in preoperatively anemic elective surgery patients. This uncertainty results from both the low quantity and quality of adverse event data due to limitations in data collection, measurement and reporting. 

The full paper, published recently in Systematic Reviews, can be found here.