Preoperative Anaemia: No Blood Transfusion, Mortality Benefits With Intravenous Iron

Sarfaroj Khan 

Disclosures

September 11, 2020

Takeaway

  • The administration of preoperative intravenous (IV) iron increased haemoglobin concentration in patients with anaemia before elective major abdominal surgery, but did not reduce the frequency of blood transfusion or mortality compared with placebo.

Why this matters

  • Findings suggest that current guidance on preoperative iron therapy should be revised and now state that preoperative iron therapy is not recommended in major elective surgery patients with anaemia.

Study design

  • In this PREVENTT trial, 487 patients with anaemia undergoing elective major open abdominal surgery were randomly assigned (1:1) to receive IV iron or placebo 10-42 days before surgery.

  • Co-primary outcomes: risk of the composite outcome of blood transfusion or mortality and number of blood transfusion episodes from randomisation to 30 days post-operatively.

  • Funding: UK National Institute of Health Research Health Technology Assessment Program.

Key results

  • No significant difference was observed between IV iron and placebo groups in:

    • composite outcomes of blood transfusion or mortality (risk ratio, 1.03; 95% CI, 0.78-1.37; P=.84); and

    • blood transfusion episodes (rate ratio [RR], 0.98; 95% CI, 0.68-1.43; P=.93).

  • The mean transfusion rate did not differ significantly in the IV iron vs placebo group from randomisation to 30 days after operation (0.61 vs 0.65 units, RR, 0.98; 95% CI, 0.65-1.47).

  • IV iron group showed a significant increase in haemoglobin concentrations by the time of surgery (mean difference [MD], 4.7 g/L; 95% CI, 2.7-6.8), at 8 weeks (MD, 10.7 g/L; 95% CI, 7.8-13.7) and 6 months following intervention (MD, 7.3 g/L; 95% CI, 3.6-11.1).

  • Readmissions to the hospital following surgery were significantly lower in the IV iron group in the first 8 weeks after the index operation (13% vs 22%; RR, 0.61; 95% CI, 0.40-0.91).

  • No significant differences were observed in any prespecified safety outcomes between the 2 groups.

Limitations

  • Preoperative iron deficiency was not specifically defined.

 

Richards T, Baikady RR, Clevenger B, Butcher A, Abeysiri S, Chau M, Macdougall IC, Murphy G, Swinson R, Collier T, Van Dyck L, Browne J, Bradbury A, Dodd M, Evans R, Brealey D, Anker SD, Klein A. Preoperative intravenous iron to treat anaemia before major abdominal surgery (PREVENTT): a randomised, double-blind, controlled trial. Lancet. 2020 Sep 4 [Epub ahead of print]. doi: 10.1016/S0140-6736(20)31539-7. PMID: 32896294 View abstract

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.

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