Research in context
Evidence before this study
Anaemia and iron deficiency are frequent in patients scheduled for elective cardiac surgery and preoperative anaemia is associated with an increased rate of red blood cell (RBC) transfusions and adverse clinical outcomes. Iron deficiency is of prime importance in many forms of anaemia and iron plays a pivotal part in efficient organ function such as myocardial function. We searched MEDLINE from inception until May 30, 2018, including the search terms “anaemia”, “preoperative”, “iron deficiency”, “cardiac”, “surgery”, “transfusion”, “erythropoietin”, and “iron” to identify studies assessing the effect of preoperative treatment of anaemia and iron deficiency in cardiac surgery. We identified one previous randomised trial in patients undergoing cardiac valve surgery in which a combination treatment with subcutaneous erythropoietin and intravenous iron the day prior to surgery resulted in a decrease in RBC transfusions.
Added value of this study
Our trial found that ultra-short-term (usually the day before surgery but on Friday in patients operated the next Monday) combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid reduced the need for RBC and total allogeneic blood product transfusions in patients with preoperative anaemia or isolated iron deficiency undergoing elective cardiac surgery.
Implications of all the available evidence
Physicians should routinely measure haemoglobin and iron parameters in patients undergoing cardiac surgery and consider combination treatment of preoperative anaemia or iron deficiency even the day prior to surgery. This is of particular relevance since a growing percentage of elective cardiac surgery is done within a few days after an acute cardiac event.