Use of preoperative erythropoietin-stimulating agents is associated with decreased thrombotic adverse events compared to red blood cell transfusion in surgical patients with anaemia.

IF 1.8 4区医学 Q3 HEMATOLOGY

Vox Sanguinis Pub Date : 2024-11-01 Epub Date: 2024-08-21 DOI:10.1111/vox.13729

Una E Choi, Ryan C Nicholson, Steven M Frank, Stephanie Cha, Brian C Cho, Jennifer S Lawton, Laeben C Lester, Nadia B Hensley

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引用次数: 0

Abstract

Background and objectives: Preoperative red blood cell (RBC) transfusions increase post-operative venous thromboembolic (VTE) events. Erythropoietin-stimulating agents (ESAs) increase VTE risk in cancer patients; we aimed to assess ESA versus RBC-associated VTE risks in a broad population of surgical patients.

Materials and methods: We queried TriNetX Diamond Network from 2006 to 2023, comparing patients with anaemia within 3 months preoperatively who received preoperative ESAs with or without intravenous (IV) iron to patients who received preoperative RBCs. Sub-analyses included (1) all surgeries and (2) cardiovascular surgeries. We propensity score matched for demographics, comorbidities, medical services, post-treatment haemoglobin (g/dL) and, for all-surgery comparisons, surgery type. Outcomes included 30-day post-operative mortality, VTE, pulmonary embolism (PE), disseminated intravascular coagulation (DIC) and haemoglobin.

Results: In our 19,548-patient cohorts, compared with preoperative RBC transfusion, ESAs without IV iron were associated with lower mortality (relative risk [RR] = 0.51 [95% confidence interval (CI), 0.45-0.59]), VTE (RR = 0.57 [0.50-0.65]) and PE (RR = 0.67 [0.54-0.84]). Post-operative haemoglobin was higher in the ESA without IV iron cohort compared with the transfusion cohort (10.0 ± 1.4 vs. 9.4 ± 1.8 g/dL, p = 0.002). Cardiac surgical patients receiving ESAs with or without IV iron had lower risk for post-operative mortality, VTE and PE (p < 0.001) than those receiving RBCs. Post-operative haemoglobin differed between patients receiving ESAs with IV iron versus RBCs (10.1 ± 1.5 vs. 9.4 ± 1.9 g/dL, p = 0.0009).

Conclusion: Compared with surgical patients who were transfused RBCs, ESA recipients had reduced 30-day post-operative risk of mortality, VTE, PE and DIC and increased haemoglobin levels. IV iron given with ESAs improved mortality.

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与输注红细胞相比，手术前使用促红细胞生成素刺激剂可减少贫血手术患者的血栓不良事件。

背景和目的：术前输注红细胞（RBC）会增加术后静脉血栓栓塞（VTE）事件。促红细胞生成素刺激剂（ESAs）会增加癌症患者的 VTE 风险；我们旨在评估 ESA 与 RBC 相关的 VTE 风险在广大手术患者中的情况：我们查询了 2006 年至 2023 年期间的 TriNetX Diamond 网络，比较了术前 3 个月内贫血、术前接受 ESA 并静脉注射 (IV) 或不静脉注射 (IV) 铁剂的患者与术前接受 RBC 的患者。子分析包括 (1) 所有手术和 (2) 心血管手术。我们对人口统计学、合并症、医疗服务、治疗后血红蛋白（g/dL）进行了倾向评分匹配，并对所有手术进行了手术类型比较。结果包括术后30天死亡率、VTE、肺栓塞（PE）、弥散性血管内凝血（DIC）和血红蛋白：在我们的 19,548 例患者队列中，与术前输注红细胞相比，不静脉注射铁剂的 ESA 可降低死亡率（相对风险 [RR] = 0.51 [95% 置信区间 (CI)，0.45-0.59]）、VTE（RR = 0.57 [0.50-0.65]）和 PE（RR = 0.67 [0.54-0.84]）。与输血队列相比，未静脉注射铁剂的ESA队列术后血红蛋白更高（10.0 ± 1.4 vs. 9.4 ± 1.8 g/dL，P = 0.002）。接受或不接受静脉注射铁剂的心脏手术患者术后死亡、VTE 和 PE 的风险较低（P=0.002）：与输注红细胞的手术患者相比，接受 ESA 的患者术后 30 天的死亡、VTE、PE 和 DIC 风险降低，血红蛋白水平升高。静脉注射铁剂和 ESAs 可改善死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Vox Sanguinis 医学-血液学

CiteScore

4.40

自引率

11.10%

发文量

156

审稿时长

6-12 weeks

期刊介绍： Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections: 1) Transfusion - Transmitted Disease and its Prevention: Identification and epidemiology of infectious agents transmissible by blood; Bacterial contamination of blood components; Donor recruitment and selection methods; Pathogen inactivation. 2) Blood Component Collection and Production: Blood collection methods and devices (including apheresis); Plasma fractionation techniques and plasma derivatives; Preparation of labile blood components; Inventory management; Hematopoietic progenitor cell collection and storage; Collection and storage of tissues; Quality management and good manufacturing practice; Automation and information technology. 3) Transfusion Medicine and New Therapies: Transfusion thresholds and audits; Haemovigilance; Clinical trials regarding appropriate haemotherapy; Non-infectious adverse affects of transfusion; Therapeutic apheresis; Support of transplant patients; Gene therapy and immunotherapy. 4) Immunohaematology and Immunogenetics: Autoimmunity in haematology; Alloimmunity of blood; Pre-transfusion testing; Immunodiagnostics; Immunobiology; Complement in immunohaematology; Blood typing reagents; Genetic markers of blood cells and serum proteins: polymorphisms and function; Genetic markers and disease; Parentage testing and forensic immunohaematology. 5) Cellular Therapy: Cell-based therapies; Stem cell sources; Stem cell processing and storage; Stem cell products; Stem cell plasticity; Regenerative medicine with cells; Cellular immunotherapy; Molecular therapy; Gene therapy.