Elektronisk udgave - Sundhedsstyrelsen

◆ Blood savings: A mean of 1.35 (0.75-1.95) fewer units of allogeneic
blood was given to TXA-treated patients in the 6 trials that reported this
outcome.
Seven trials made a “head to head” comparison between TXA and aprotinin.
The use of TXA was associated with a (relative) 21% increase in the risk of requiring
allogeneic blood (RR 1.21 (0.83-1.76)), compared with aprotinin.
However, this difference did not reach statistical significance. It was concluded
that there may be no difference between aprotinin and TXA in their blood-sparing
effects, particularly in cardiac surgery. TXA is substantially cheaper than
aprotinin, despite the evidence of comparable efficacy. This lower price has to
be set against the greater uncertainty about its effect, as there is much more information
available for aprotinin (due to a larger number of trials and patients).
EPO
Overall, 21 studies were included in the review.
EPO alone. ISPOT-results (orthopedic and cardiac surgery)
There were three randomized trials of EPO alone in orthopedic surgery
(14, 119, 120) with a total of 684 patients (439 of them randomized
to receive EPO), and two studies in cardiac surgery (121,
122) with a total of 108 patients (of whom 61 were randomized to
receive EPO).
❖ EPO reduced the rate of transfusion of allogeneic blood in orthopedic
surgery by a (relative) 64% (OR 0.36 (0.24-0.56)). In studies
with cardiac patients the (relative) reduction rate was 75%
(OR 0.25 (0.06-1.04)).
❖ Complications: There was no convincing evidence that EPO
alone increased the frequency of thrombotic complications (4%
in EPO-treated patients and 9% in those on placebo). However,
one study in cardiac surgery reported 7 deaths within 2 months
of surgery in 126 patients treated with EPO and no death in 56
who received placebo (121). Four of the death were thrombotic
or vascular events.
EPO to augment autologous donation. ISPOT-results (orthopedic and cardiac
surgery)
Most studies evaluating EPO to augment pre-operative autologous
donation (PAD) were performed on orthopedic patients. There
were 11 studies including a total of 825 patients (123-133), of
whom 493 were randomized to receive EPO. The median sample
size was 62 patients.
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