Steuber Taylor D, Howard Meredith L, Nisly Sarah A
Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, USA Indiana University Health, Methodist Hospital, Indianapolis, IN, USA
University of North Texas System College of Pharmacy, Fort Worth, TX, USA.
Ann Pharmacother. 2016 Jul;50(7):578-85. doi: 10.1177/1060028016647977. Epub 2016 May 4.
To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use.
A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesis-stimulating agents, and erythropoietin.
All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery patients were evaluated, provided they reported blood transfusion outcomes.
A total of 9 prospective and retrospective studies and 1 meta-analysis were identified and included. In the preoperative setting, administration of oral iron, IV iron, or ESA alone or in combination to correct underlying anemia led to significantly reduced transfusion rates. Transfusion requirements were generally less with combination therapy (ESA + oral or IV iron). In the short-term perioperative or postoperative period, use of oral or IV iron led to conflicting results, with some reporting a statistically significant reduction in blood transfusions, whereas others reported none.
In elective orthopedic surgery, IV or oral iron with or without an ESA may provide benefit in prevention of postoperative anemia and results in blood transfusion reduction without significantly increasing the risk of adverse events. These agents should be considered at the lowest effective dose with emphasis on administration prior to planned surgery.
评估口服铁剂、静脉注射铁剂和促红细胞生成素用于择期骨科手术患者围手术期贫血的预防和管理，并提供临床应用算法。
使用以下检索词单独或组合检索1964年至2016年3月的PubMed和MEDLINE数据库：骨科、手术、择期、贫血、输血、铁、促红细胞生成素和红细胞生成素。
评估所有评估单独或联合使用口服铁剂、静脉注射铁剂或促红细胞生成素用于择期骨科手术患者的英文前瞻性和回顾性人体研究及荟萃分析，前提是这些研究报告了输血结果。
共识别并纳入9项前瞻性和回顾性研究及1项荟萃分析。在术前，单独或联合使用口服铁剂、静脉注射铁剂或促红细胞生成素纠正潜在贫血可显著降低输血率。联合治疗（促红细胞生成素+口服或静脉注射铁剂）的输血需求通常较少。在围手术期短期或术后，口服或静脉注射铁剂的使用结果存在矛盾，一些研究报告输血有统计学显著减少，而另一些研究则未报告有减少。
在择期骨科手术中，静脉注射或口服铁剂（无论是否联合促红细胞生成素）可能有助于预防术后贫血并减少输血，且不会显著增加不良事件风险。应考虑以最低有效剂量使用这些药物，并强调在计划手术前给药。
