Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Cardiac Surgery Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Vox Sang. 2024 Nov;119(11):1174-1182. doi: 10.1111/vox.13729. Epub 2024 Aug 21.
Preoperative 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.
We 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.
In 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).
Compared 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.
术前输注红细胞（RBC）会增加术后静脉血栓栓塞（VTE）事件的发生。促红细胞生成素刺激剂（ESA）会增加癌症患者的 VTE 风险；我们旨在评估广泛手术患者中 ESA 与 RBC 相关的 VTE 风险。
我们从 2006 年至 2023 年在 TriNetX Diamond 网络中进行了查询，比较了术前 3 个月内贫血且接受术前 ESA 联合或不联合静脉（IV）铁治疗与接受术前 RBC 治疗的患者。亚分析包括（1）所有手术和（2）心血管手术。我们进行了倾向评分匹配，以匹配患者的人口统计学、合并症、医疗服务、治疗后血红蛋白（g/dL），并对所有手术进行了比较，以匹配手术类型。结果包括术后 30 天死亡率、VTE、肺栓塞（PE）、弥漫性血管内凝血（DIC）和血红蛋白。
在我们的 19548 例患者队列中，与术前 RBC 输血相比，不联合 IV 铁的 ESA 与较低的死亡率（相对风险 [RR] = 0.51 [95%置信区间 [CI]，0.45-0.59]）、VTE（RR = 0.57 [0.50-0.65]）和 PE（RR = 0.67 [0.54-0.84]）相关。与输血组相比，不联合 IV 铁的 ESA 组术后血红蛋白水平更高（10.0 ± 1.4 vs. 9.4 ± 1.8 g/dL，p = 0.002）。接受 ESA 联合或不联合 IV 铁治疗的心脏手术患者术后死亡率、VTE 和 PE 的风险低于接受 RBC 治疗的患者（p < 0.001）。与接受 IV 铁 ESA 治疗的患者相比，接受 RBC 治疗的患者术后血红蛋白水平不同（10.1 ± 1.5 vs. 9.4 ± 1.9 g/dL，p = 0.0009）。
与接受 RBC 输血的手术患者相比，ESA 接受者的术后 30 天死亡率、VTE、PE 和 DIC 风险降低，血红蛋白水平升高。ESA 联合 IV 铁可改善死亡率。
