Erythropoietin therapy in the perioperative setting

Citation
Lt. Goodnough et Tg. Monk, Erythropoietin therapy in the perioperative setting, CLIN ORTHOP, (357), 1998, pp. 82-88
Citations number
44
Categorie Soggetti
Ortopedics, Rehabilitation & Sport Medicine","da verificare
Journal title
CLINICAL ORTHOPAEDICS AND RELATED RESEARCH
ISSN journal
0009921X → ACNP
Issue
357
Year of publication
1998
Pages
82 - 88
Database
ISI
SICI code
0009-921X(199812):357<82:ETITPS>2.0.ZU;2-T
Abstract
Recombinant human erythropoietin has been approved for use in patients unde rgoing autologous donation in Japan, Europe, and Canada since 1993, 1994, a nd 1996, respectively, and for perisurgical adjuvant therapy without autolo gous donation in Canada and the United States since 1996, Early clinical tr ials of erythropoietin therapy in the setting of autologous donation have p rovided important information regarding clinical safety, erythropoietin dos e, and erythropoietic response. Later trials of perisurgical erythropoietin therapy without autologous donation provided data on efficacy (reduced all ogeneic blood exposure) that led to approval of erythropoietin in patients undergoing surgery. However, the erythropoietin doses (300 U/kg subcutaneou s x14 days) used in these trials, and their subsequent inclusion in labelin g for the use of this product, are costly and tedious to administer. A rece nt study reported that a weekly regimen of erythropoietin (600 U/kg) for 4 weeks is less costly but just as effective at reducing allogeneic blood exp osure in elective orthopaedic surgery. The most cost effective regimen that has been shown to minimize allogeneic exposure is preoperative erythropoie tin therapy (600 U/kg subcutaneous weekly x2 and 300 U/kg subcutaneous on d ay of surgery) coupled with acute normovolemic hemodilution in patients und ergoing radical retropubic prostatectomy. A similar regimen of erythropoiet in therapy in patients undergoing coronary artery bypass grafting (2500 U/k g subcutaneous in divided doses for 2 weeks preoperatively) coupled with he modilution also was effective. Low dose erythropoietin therapy coupled with acute normovolemic hemodilution ultimately may be shown to he cost equival ent to the predonation of three autologous blood units before elective surg ery.