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Ann Thorac Surg 1997;64:1686-1693
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Effect of Recombinant Human Erythropoietin on Transfusion Risk in Coronary Bypass Patients

Michael N. D'Ambra, MD, Richard J. Gray, MD, Robert Hillman, MD, James W. Jones, MD, PhD, Hugh C. Kim, MD, Robert Rawitscher, MD, Harold Schnaper, MD, Irma Szymanski, MD, Gus J. Vlahakes, MD, David Kaplan, MD, Karen E. Lynch, BSN, Mary Guilfoyle, MS, Robert I. Abels, MD

Cardiac Anesthesia Group, Massachusetts General Hospital, Boston, Massachusetts; Division of Cardiac Surgery, Cedar-Sinai Medical Center, Los Angeles, California; Department of Medicine, Maine Medical Center, South Portland, Maine; Department of Surgery, Baylor College of Medicine and Veterans Administration Medical Center, Houston, Texas; Division of Hematology, Robert Wood Johnson Medical School, New Brunswick, New Jersey; Department of Surgery, Ritter Heart Institute at the Toledo Hospital, Toledo, Ohio; Center for Aging, University of Alabama Medical Center, Birmingham, Alabama; Blood Transfusion Services, University of Massachusetts Medical Center, Worcester, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts; and The Robert Wood Johnson Pharmaceutical Research Institute, Raritan, New Jersey

Accepted for publication May 28, 1997.

Background. Patients having a cardiac operation frequently require allogeneic blood transfusions despite surgical blood-conservation techniques. Recombinant human erythropoietin (Epoetin alfa) may augment this conservation by stimulating erythropoiesis. The safety and efficacy of perioperative use of Epoetin alfa to reduce the need of allogeneic transfusion was studied.

Methods. A multicenter double-blind, placebo-controlled, parallel-group study involved 182 patients having coronary artery bypass grafting and randomized to receive Epoetin alfa (300 or 150 IU/kg) or placebo subcutaneously for 5 days before, on the day of, and for 2 days after operation.

Results. Perioperative Epoetin alfa resulted in greater increases in baseline to preoperative hemoglobin levels and hematocrit (300 IU/kg) and in presurgery to postsurgical day 1 reticulocyte counts versus placebo (p <= 0.05). However, there was no significant difference in transfusion requirements. Incidences of adverse events were similar in all study groups.

Conclusions. Lower incidences of allogeneic blood exposure were observed in both Epoetin alfa–treated groups; however, the differences between all treatment groups were not significant. This was probably due to the relatively short 5-day preoperative course of Epoetin alfa therapy. There were no significant differences between the three groups relative to safety. Epoetin alfa was well tolerated in this population.


Related Article

Erythropoietin Therapy in Patients Undergoing Cardiac Operations
Lawrence T. Goodnough, George J. Despotis, and Curtis A. Parvin
Ann. Thorac. Surg. 1997 64: 1579-1580. [Extract] [Full Text]





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