EFFECT OF RECOMBINANT-HUMAN-ERYTHROPOIETIN ON TRANSFUSION RISK IN CORONARY-BYPASS PATIENTS

Background. Patients having a cardiac operation frequently require all ogeneic blood transfusions despite surgical blood-conservation techniq ues. 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 tr ansfusion was studied. Methods. A multicenter double-blind, placebo-co ntrolled, parallel-group study involved 182 patients having coronary a rtery bypass grafting and randomized to receive Epoetin alfa (300 or 1 50 IU/kg) or placebo subcutaneously for 5 days before, on the day of, and for 2 days after operation. Results. Perioperative Epoetin alfa re sulted in greater increases in baseline to preoperative hemoglobin lev els and hematocrit (300 IU/kg) and in presurgery to postsurgical day 1 reticulocyte counts versus placebo (p less than or equal to 0.05). Ho wever, there was no significant difference in transfusion requirements . Incidences of adverse events were similar in all study groups. Concl usions. Lower incidences of allogeneic blood exposure were observed in both Epoetin alfa-treated groups; however, the differences between al l treatment groups were not significant. This was probably due to the relatively short 5-day preoperative course of Epoetin alfa therapy. Th ere were no significant differences between the three groups relative to safety. Epoetin alfa was well tolerated in this population. (C) 199 7 by The Society of Thoracic Surgeons.