Affiliation:
1. Department of Anesthesiology and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA
2. Cardiac Surgery Division, Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA
Abstract
AbstractBackground and ObjectivesPreoperative 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 MethodsWe 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.ResultsIn 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).ConclusionCompared 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.