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Preoperative Very Short Term High Dose Erythropoietin Administration Diminishes Blood Transfusion Rate in Off Pump Coronary Artery Bypass. A Randomized Blind Controlled Study
Luca Weltert, Stefano D'Alessandro, Saverio Nardella, Fabiana Girola, Alessandro Bellisario, Daniele Maselli, Ruggero De Paulis; European Hospital, Rome, Italy
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Objective: Human Recombinant Erythropoietin (HRE) has been used either as a single or refracted dose, to obtain rapid increase in red blood cells count a few days before surgery. The shortest preparatory administration interval up to now was 4 days. In everyday routine at our Institution only 2,4 days separate average hospitalization and surgery. We therefore propose a randomized blind trial to test the efficacy of high dose HRE in very short term administration.
Methods: All patients presenting with diagnosis of isolated coronary vessels disease were randomized to either HRE administration or control group. Patients with Creatinin >2 mg/dl, Hb >14.5 g/dl or Hematocrit > 44% were excluded. Administration doses were:
Day -2, 14.000UI; Day -1, 14.000UI; Day 0 (Day of surgery), 8.000UI; Day 1, 8.000UI; Day 2, 8.000UI (average 600UI/Kg/Week). Haemoglobin (Hb) values were collected preoperatively, and on postoperative day 1 and day 4. Blood loss and blood transfusion rate were recorded at time of discharge.
Results: Three-hundred-twenty consecutive patients were enrolled. All patients underwent OFF-pump coronary revascularization. No significant difference were present in Age, Ejection Fraction, Euroscore value, incidence of COPD, peripheral vasculopathy, instable angina, recent myocardial infarction, postoperative blood loss. Mean preoperative Hb value were similar between the two groups (p>0,3). Three patients required conversion to On-Pump revascularization and were excluded from the study. At Day 4 mean Hb was 15,5% higher in the HRE group (10.70±0.72 vs 9.26±0.71 g/dl; p<0,05). The HRE group required 0,33 blood units/per patients while the control group required 0,76 blood units/per patient (p=0,008).
Conclusion: A significant reduction in transfusion rate and a significant increase in Hb values in HRE group were observed. No adverse events (thrombosis, allergic reactions) related to HRE administration were recorded. A very short preoperative HRE administration seem a safe, easy, and convenient method in reducing the need for blood transfusions.
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