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Erythropoietin with Iron Supplementation To Prevent Allogeneic Blood Transfusion in Total Hip Joint Arthroplasty: A Randomized, Controlled Trial

Brian G. Feagan, MD; Cindy J. Wong, MSc; Alexandra Kirkley, MD; D.W.C. Johnston, MD; Frank C. Smith, MD; Paul Whitsitt, MD; Susan L. Wheeler, RN; and Catherine Y. Lau, PhD
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Copyright ©2004 by the American College of Physicians

Ann Intern Med. 2000;133(11):845-854. doi:10.7326/0003-4819-133-11-200012050-00008
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Background: The optimum regimen of epoetin alfa for prevention of allogeneic blood transfusion is unknown.

Objective: To determine whether a modified regimen of epoetin alfa reduces allogeneic blood transfusion in patients undergoing hip arthroplasty.

Design: Randomized, double-blind, multicenter trial comparing two modified dose regimens of epoetin alfa with placebo.

Setting: 13 teaching hospitals and 4 community hospitals in Canada.

Patients: 201 patients undergoing primary hip arthroplasty who had a hemoglobin concentration of 98 to 137 g/L and did not predonate blood.

Intervention: Patients were assigned in a 3:5:5 ratio to receive four weekly doses of epoetin alfa, 40 000 U (high-dose; n = 44) or 20 000 U (low-dose; n = 79), or placebo (n = 78), starting 4 weeks before surgery. All patients received oral iron supplementation, 450 mg/d, for 42 or more days before surgery.

Measurements: The primary end point was allogeneic transfusion. Secondary end points were thromboembolic events and change in reticulocyte count and hemoglobin concentration.

Results: Both modified epoetin alfa regimens significantly reduced the need for allogeneic transfusion: Five (11.4%) patients in the high-dose group (P = 0.001) and 18 (22.8%) patients in the low-dose group (P = 0.003) had transfusion, compared with 35 (44.9%) patients in the placebo group. The hematologic response was substantial in patients who received epoetin alfa. In the high-dose group, low-dose group, and placebo group, the preoperative increase in reticulocyte count was 58.8, 37.0 and 1.8 × 109 cells/L (P < 0.001), respectively, and the increase in hemoglobin concentration was 19.5, 17.2, and 1.2 g/L (P < 0.001). The incidence of thromboembolic events did not differ among groups.

Conclusions: Both modified epoetin alfa regimens were effective compared with placebo in reducing allogeneic transfusion in patients undergoing hip arthroplasty. Patients who received high-dose epoetin alfa had the lowest transfusion rate.


Grahic Jump Location
Figure 2.
Reticulocyte count and hemoglobin concentration among patient groups.

POD = postoperative day.

Grahic Jump Location




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