Preoperative Intravenous Iron Reduces Transfusions in Anemic Patients Undergoing Cardiac Surgery

An international randomized trial found that a single dose of intravenous iron given before elective cardiac surgery reduced red cell transfusions and modestly increased the time patients spent alive and at home in the 90 days after surgery. The findings were published recently in The BMJ.

The Intravenous iron to Treat Anemia before Cardiac Surgery (ITACS) trial included 955 adults with anemia undergoing elective cardiac surgery across 33 hospitals in 10 countries. Participants received either 1,000 mg of intravenous iron or placebo one to 26 weeks before surgery.

Red cell transfusions were given to 61.1% of patients in the iron group and 68.2% of those in the placebo group during their hospital stay. The researchers reported that intravenous iron supplementation saved approximately 44 units of blood products for every 100 patients treated. Iron also increased preoperative hemoglobin concentrations, and more patients had their anemia corrected by the day of surgery.

Patients who received iron had a median of 81.1 days alive and at home, compared with 80.0 days for those who received placebo, an adjusted median difference of one day. The benefit appeared larger among patients with the poorest recovery.

The researchers found no significant differences in major complications or length of hospital stay. Hypophosphatemia occurred more frequently in patients who received intravenous iron, while there was no evidence of an increased risk of infection.