Elektronisk udgave - Sundhedsstyrelsen

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❖ In orthopedic surgery EPO reduced the rate of transfusion of
allogeneic blood by (relative) 58% (OR 0.42 (0.28-0.62)),
which is a statistically significant decrease.
❖ There was no difference between the efficacy of high and low doses
of EPO (OR 0.41 (0.26-0.65)) versus 0.48 (OR 0.24-0.96)).
The efficacy associated with subcutaneous EPO was higher than
for intravenous use, but this difference was not statistically significant
(OR 0.32 (0.18-0.57)) versus OR 0.52 (0.31-0.89)).
❖ Blood savings: The findings on saving of allogeneic blood were
very small (mean 0.14 (0.04-0.34) units) in the trials that reported
that outcome.
In cardiac surgery there were 5 studies (134-138), only involving
224 patients – of whom 154 were randomized to receive EPO.
❖ The (relative) reduction of the transfusion rate in cardiac surgery
was 75% (OR 0.25 (0.08-0.82)).
Australian update (orthopedic, cardiac and other types of surgery)
28 trials (14, 119-130, 132-146) – mostly in orthopedic and cardiac surgery –
included 2295 patients, of whom 1429 were randomized to receive EPO. In 6
trials EPO was used alone prior to surgery, in 19 trials EPO was used as an adjunct
to PAD, and was compared to PAD alone.
◆ All trials included, EPO reduced the rate of transfusion of allogeneic
blood by a (relative) 46% (RR 0.54(0.43-0.68)).
◆ The absolute risk reduction was 14.5%, and on average 7 patients would
have to be treated with EPO so that one would avoid allogeneic transfusion
(NNT 6.9 (5.0-11.1)).
◆ The relative risk reduction did not seem to vary to any significant degree
according to whether the drug was used alone or in combination with other
interventions, particularly PAD. However, the effect seemed less marked
when EPO was used alone.
◆ There seemed to be a modest dose response relationship (greatest effect
when high dose was given). However, this was based on limited data.
◆ There was no convincing evidence that the mode of administration of
EPO (intravenously or subcutaneously) modified its efficacy.
◆ Overall, the relative benefits of EPO in cardiac and orthopedic surgery seemed
comparable. In cancer surgery (where the number of trials was
small), no benefit of EPO was seen.
◆ Blood savings: The findings on saving of allogeneic blood were very
small (a quarter of a unit) and inconsistent across the small number of
studies that reported this outcome.
◆ Transfusion protocol: The relative benefits of EPO used alone appeared
to be less when the drug was employed with a transfusion protocol than
when no protocol was used. This trend was not seen when EPO was
combined with PAD.