Intravenous iron administration before cardiac surgery reduces red blood cell transfusion in non-anemic patients.

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Abstract Submission 

Tom Friedman (1), Eldad Dan (2), Maged Makhoul (3), Roi Glam (4), Anastasia Weis (3), Derrick Tam (5), Gil Bolotin (1)

(1) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel., Haifa, Israel, (2) Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel, Haifa, NA, (3) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel., Haifa, NA, (4) Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel, Haifa, NA, (5) Sunnybrook Health Sciences Centre, Toronto, ON

Tom Friedman    -  Contact Me
Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.

Eldad Dan    -  Contact Me
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

Maged Makhoul    -  Contact Me
Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.

Roi Glam    -  Contact Me
Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel

Anastasia Weis    -  Contact Me
Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.

Derrick Tam    -  Contact Me
Sunnybrook Health Sciences Centre

Gil Bolotin    -  Contact Me
Department of Cardiac Surgery, Rambam Health Care Campus, Haifa, Israel.

Tom Friedman    -  Contact Me
Rambam

Objective: Reducing need for blood transfusion among patients undergoing cardiac surgery has potential to reduce post-operative complications and mortality. Our study aimed to assess effects of pre-operative intravenous ferric carboxymaltose (FCM) on post-surgical red blood cell (RBC) transfusion requirements in non-anemic patients undergoing cardiac surgery.

Methods: A double-blind, randomized, single center, placebo-control trial conducted between Oct 2016-Nov 2019, with follow-up period of up to 6 weeks post-operation. Participants were non-anemic patients undergoing non-emergent on-pump cardiac surgery, received intravenous iron in form of FCM or placebo, administered once 24-72 hours before surgery.
Primary outcome- number of RBC units transfused during first 4 post-operative days. Secondary outcomes- Blood hemoglobin levels at 4-days and 6-weeks post-operation.

Results: We randomized 200 patients, where 194 were included, 99 patients in FCM group vs 95 in placebo group; mean age (62.9±9.1 and 62.9±9.1 respectively) and gender (87% males) equally distributed between the groups. By day 4 post-surgery, a significantly lower mean number of RBC units were transfused in FCM than placebo group (0·3±0·9 vs 1·6±4·5, respectively; p=0·006). Number of patients receiving RBCs in FCM and placebo groups was 19 (19%) and 34 (36%), respectively [OR 0·42(95%CI 0·22-0·88); p=0·01]. Mean hemoglobin levels on day 4 post-surgery were 9·7±1 g/dl vs. 9·3±1 g/dl, respectively (p=0·03). Corresponding values at 6-weeks post-surgery were 12·6±1·4 g/dl vs. 11·8±1·5 g/dl, respectively (p=0·012).

Conclusion: In non-anemic patients undergoing on-pump cardiac surgery, pre-treatment with single FCM dose of 1000 mg within 1-3 days pre-surgery significantly reduced the need for postoperative RBC transfusions and improved both serum iron level, transferrin saturation and hemoglobin levels.

Critical Care (Cardiogenic Shock (non-MCS), All Post-operative Care)