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Richard N, Arab-Hocine N, Vannier M, Leblanc-Boubchir R, Pelaquier A, Boruchowicz A, Musikas M, Amil M, Fumery M, Nahon S, Arotcarena R, Gelsi E, Maurin A, Hébuterne X, Savoye G. Efficacy of ferric carboxymaltose on haemoglobin response among older patients with gastrointestinal bleeding: a randomised clinical trial. Age Ageing 2024; 53:afae085. [PMID: 38706390 DOI: 10.1093/ageing/afae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Acute gastrointestinal bleeding (AGIB) is common in older patients but the use of iron in this context remains understudied. AIMS This study aimed to evaluate prospectively the efficacy of ferric carboxymaltose to treat anaemia in older patients after AGIB. METHODS This randomised double-blinded placebo-controlled clinical trial was conducted in 10 French centres. Eligible patients were 65 years or more, had controlled upper or lower gastrointestinal bleeding and a haemoglobin level of 9-11 g/dl. Patients were randomly assigned, in a 1:1 ratio, to receive either one intravenous iron injection of ferric carboxymaltose or one injection of saline solution. The primary endpoint was the difference in haemoglobin level between day 0 and day 42. Secondary endpoints were treatment-emergent adverse events, serious adverse events, rehospitalisation and improvement of quality of life (QOL) at day 180. RESULTS From January 2013 to January 2017, 59 patients were included. The median age of patients was 81.9 [75.8, 87.3] years. At day 42, a significant difference in haemoglobin level increase was observed (2.49 g/dl in the ferric carboxymaltose group vs. 1.56 g/dl in the placebo group, P = 0.02). At day 180, QOL, measured on European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, improved by 10.5 points in the ferric carboxymaltose group and by 8.2 points in the placebo group (P = 0.56). Rates of adverse events and rehospitalisation were similar in the two groups. CONCLUSIONS Intravenous iron seems safe and effective to treat anaemia in older patients after AGIB and should be considered as a standard-of-care treatment. ClinicalTrials.gov (NCT01690585).
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Affiliation(s)
- Nicolas Richard
- Department of Gastroenterology, Univ Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and microbiota-gut-brain axis", CHU Rouen, Rouen F-76000, France
| | - Nadia Arab-Hocine
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | - Margot Vannier
- Department of Biostatistics, CHU Rouen, Rouen F-76000, France
| | | | - Agnès Pelaquier
- Department of Gastroenterology, Montelimar Hospital, Montelimar, France
| | - Arnaud Boruchowicz
- Department of Gastroenterology, Valenciennes Hospital, Valenciennes, France
| | - Marietta Musikas
- Department of Gastroenterology, Caen University Hospital, Caen, France
| | - Morgane Amil
- Department of Gastroenterology, La Roche Sur Yon Hospital, La Roche Sur Yon, France
| | - Mathurin Fumery
- Department of Gastroenterology, Amiens University and Hospital, Amiens, France
| | - Stéphane Nahon
- Department of Gastroenterology, Le Raincy - Montfermeil Hospital -, Le Raincy, Montfermeil, France
| | | | - Eve Gelsi
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | - Arnaud Maurin
- Department of Gastroenterology, Le Mans Hospital, Le Mans, France
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice and University Côte d'Azur, Nice, France
| | - Guillaume Savoye
- Department of Gastroenterology, Univ Rouen Normandie, INSERM, ADEN UMR1073, "Nutrition, Inflammation and microbiota-gut-brain axis", CHU Rouen, Rouen F-76000, France
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Li M, Wright A, Rahim AM, Tan KH, Tagore S. Retrospective Study Comparing Treatment Outcomes in Obstetric Patients With Iron Deficiency Anemia Treated With and Without Intravenous Ferric Carboxymaltose. Cureus 2024; 16:e55713. [PMID: 38586790 PMCID: PMC10998652 DOI: 10.7759/cureus.55713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Iron deficiency anemia is associated with an increased risk of adverse maternal and perinatal outcomes. Intravenous iron preparation containing ferric carboxymaltose has been shown to be a safe and effective way of increasing hemoglobin (Hb) and mean corpuscular volume (MCV) levels and reducing the need for blood transfusion. In our center, it used to be given as an inpatient procedure because of the risks of potential drug reactions. In 2021, we initiated the administration of intravenous ferric carboxymaltose as an outpatient procedure. We compared the outcomes of patients between 2021 and 2023 after the initiation of outpatient administration of intravenous ferric carboxymaltose in 127 obstetric patients with iron deficiency anemia in the second and third trimesters. Methods In this study conducted in a large maternity unit in Singapore between 2021 to 2023, we compared the changes in maternal hematological parameters among obstetric patients with iron deficiency anemia presenting to the day care unit in the second or third trimester with a Hb level of <8 g/dl treated with a single dose of ferric carboxymaltose injection (Ferinject) against a control group who were referred for treatment but defaulted on and declined treatment. Results Ferric carboxymaltose significantly increased the Hb and MCV levels at delivery in obstetric patients with iron deficiency. The mean Hb at delivery was 10.8 g/dL in the case group compared to 8.8 g/dL in the control group. The percentage of patients with Hb ≥10.0 g/dL was 73.4% in the case group compared to 27.8% in the control group. The incidence of adverse side effects was low and mild (2/127; 1.6%). None of the patients received were hospitalized because of ferric carboxymaltose. Conclusion A single injection dose of ferric carboxymaltose as an outpatient antenatal procedure was easily administered and well tolerated. Obstetric patients with iron deficiency anemia who received intravenous ferric carboxymaltose had a significantly higher level of Hb than those who did not.
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Affiliation(s)
- Mingyue Li
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Ann Wright
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
| | - Asmira M Rahim
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Kok Hian Tan
- Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, SGP
| | - Shephali Tagore
- Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, SGP
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Miah MMZ, Pramanik MEA, Rafi A, Akhter M. Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh. Euroasian J Hepatogastroenterol 2024; 14:12-15. [PMID: 39022215 PMCID: PMC11249889 DOI: 10.5005/jp-journals-10018-1422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 03/04/2024] [Indexed: 07/20/2024] Open
Abstract
Gastrointestinal bleeding is the most common cause of iron deficiency in adult men and menstrual blood loss is the leading cause of iron insufficiency in women, anemia due to iron deficiency is mostly caused by blood loss. Ferric carboxymaltose (FCM) is a contemporary parenteral iron formulation that may be used therapeutically to treat anemia caused by an iron deficiency [iron-deficiency anemia (IDA)]. The main goal of the trial was to evaluate FCM's safety and efficacy in treating IDA. The Department of Hematology, Rajshahi Medical College Hospital, Rajshahi, Bangladesh participated in this quasi-experimental research, which comprised adult patients with IDA. Participants were given an intravenous (IV) infusion of 500 mg of FCM, diluted in 100 mL of 0.9% normal saline, throughout a 30-minute period after their participation. The second dosage of FCM was administered after a 7-day period of the first dose. The comparison of the outcomes [hemoglobin (Hb) level, serum ferritin level, and other hematological parameters] between the baseline and day 14 postintervention was done using a paired t-test. Compared to baseline, patients' Hb levels rose considerably (p = 0.001) after FCM. Aside from serum ferritin level, additional hematological parameters that sharply increased were red blood cells (RBCs) count, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width - coefficient of variation (RDW-CV), and iron indicators. The experiment recorded mild adverse effects such as fever, headaches, and gastrointestinal issues including vomiting, diarrhea, and constipation, but no significant adverse events. In summary, IDA may be effectively treated with FCM, a safe and secure IV medication that has no major negative effects. How to cite this article Miah MMZ, Pramanik MEA, Rafi A, et al. Iron-deficiency Anemia Treatment with Ferric Carboxymaltose: A Real-world Quasi-experimental Study from Bangladesh. Euroasian J Hepato-Gastroenterol 2024;14(1):12-15.
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Affiliation(s)
| | - Md Enayet Ali Pramanik
- Department of On-Farm Research Division, Barind Station, Bangladesh Agricultural Research Institute, Rajshahi, Bangladesh
| | - Abdur Rafi
- Department of Medicine, Rajshahi Medical College, Rajshahi, Bangladesh
| | - Mira Akhter
- Department of Pathology, Rajshahi Medical College, Rajshahi, Bangladesh
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Seng NWP, Barco JB, Wong MHL, Lim KX, Peh WM, Ng CT, Cushway T, Foo FJ, Koh FHX. Hypophosphatemia related to intravenous iron therapy with ferric carboxymaltose: A case series. Transfus Med 2023; 33:503-508. [PMID: 37263781 DOI: 10.1111/tme.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/28/2023] [Accepted: 04/13/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES This case series would like to highlight hypophosphatemia related to ferric carboxymaltose and its adverse clinical consequences. BACKGROUND Intravenous iron supplementation is a good alternative to oral iron replacement in iron deficiency anaemia due to its ability to correct iron deficit with minimal infusions without incurring the gastrointestinal side effects of oral iron replacement. Ferric carboxymaltose is one common formula for intravenous iron supplementation. However, an increasingly recognised adverse side-effect of intravenous ferric carboxymaltose is hypophosphatemia. There has been increasing reports and studies highlighting hypophosphatemia related to intra-venous iron therapy. Though initially thought to be transient and asymptomatic, recent studies have shown that persistent hypophosphatemia in iron therapy can result in debilitating disease including myopathy, fractures and osteomalacia. METHODS A retrospective analysis of all patients who had ferric carboxymaltose was performed. RESULTS We highlight 3 cases where hyposphatemia affected the clinical outcomes. CONCLUSION With the increased use of IV iron it is important to be aware of the high potential for hypophosphatemia secondary to ferric carboxymaltose.
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Affiliation(s)
- Nigel Wei-Peng Seng
- Ministry of Health Holdings, Singapore, Singapore
- Sengkang General Hospital, Singapore, Singapore
| | | | | | | | | | | | - Tim Cushway
- The Iron Suites Medical Centre, Singapore, Singapore
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Ito K, Mitobe Y, Inoue R, Momoeda M. Impact of nausea/vomiting on EQ-5D-5L utility scores in patients taking iron preparations for heavy menstrual bleeding or anemia. BMC Womens Health 2023; 23:505. [PMID: 37735374 PMCID: PMC10512526 DOI: 10.1186/s12905-023-02652-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The purpose of this study was to establish an estimating equation to predict the 5-level EQ-5D version (EQ-5D-5L) utility score in patients taking iron preparations for heavy menstrual bleeding (HMB) or anemia and to evaluate whether the presence of nausea or vomiting was a significant predictor of EQ-5D-5L-based quality of life. METHODS A cross-sectional survey was conducted to collect EQ-5D-5L utility scores and other patient reported outcomes from 385 patients taking iron preparations for HMB or anemia who were selected from the disease patient panel. Using the utility scores as objective variables, explanatory variable candidates were selected considering correlations, multicollinearity, and clinical validity. Predicting models were constructed using regression-based models (linear model, generalized linear model (GLM), Tobit model). Stepwise regression method was applied for selecting statistically significant (p < 0.05) predictors. Goodness-of-fit of models were assessed by mean absolute error and mean squared error (MSE). RESULTS The EQ-5D-5L utility scores (mean ± standard deviation) of 96 patients with nausea/vomiting and 289 patients without nausea/vomiting were 0.67 ± 0.16 and 0.84 ± 0.14, respectively (p < 0.001). The presence of nausea/vomiting was shown to be the most significant factor reducing the utility score in the statistical models using the explanatory variable candidates selected in the study. As the results of the goodness-of-fit test, GLM with the smallest MSE was selected to establish the estimating equation. CONCLUSION The estimating equation to predict the EQ-5D-5L utility scores in patients taking iron preparations for HMB or anemia was established. The presence of nausea/vomiting was found to be a factor significantly reducing utility scores, with a decrement of the value estimated to be -0.117. TRIAL REGISTRATION UMIN000045700 ( http://www.umin.ac.jp/ctr/ ). Registered on October 11, 2021.
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Affiliation(s)
- Kyoko Ito
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Yuko Mitobe
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Ryo Inoue
- Medical Affairs Department, Torii Pharmaceutical Co., Ltd., 3-4-1 Nihonbashi-Honcho, Chuo-ku, Tokyo, 103-8439, Japan
| | - Mikio Momoeda
- Aiiku Maternal and Child Health Center, Aiiku Hospital, 1-16-10 Shibaura, Minato-ku, Tokyo, 105-8321, Japan.
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Valvano M, Capannolo A, Cesaro N, Stefanelli G, Fabiani S, Frassino S, Monaco S, Magistroni M, Viscido A, Latella G. Nutrition, Nutritional Status, Micronutrients Deficiency, and Disease Course of Inflammatory Bowel Disease. Nutrients 2023; 15:3824. [PMID: 37686856 PMCID: PMC10489664 DOI: 10.3390/nu15173824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
During the disease course, most Inflammatory Bowel Disease patients present a condition of malnutrition, undernutrition, or even overnutrition. These conditions are mainly due to suboptimal nutritional intake, alterations in nutrient requirements and metabolism, malabsorption, and excessive gastrointestinal losses. A suboptimal nutritional status and low micronutrient serum levels can have a negative impact on both induction and maintenance of remission and on the quality of life of Inflammatory Bowel Disease patients. We performed a systematic review including all the studies evaluating the connection between nutrition, nutrition status (including undernutrition and overnutrition), micronutrient deficiency, and both disease course and therapeutic response in Inflammatory Bowel Disease patients. This systematic review was performed using PubMed/MEDLINE and Scopus. Four main clinical settings concerning the effect of nutrition on disease course in adult Inflammatory Bowel Disease patients were analyzed (induction of remission, maintenance of remission, risk of surgery, post-operative recurrence, and surgery-related complications). Four authors independently reviewed abstracts and manuscripts for eligibility. 6077 articles were found; 762 duplicated studies were removed. Out of 412 full texts analyzed, 227 were included in the review. The evidence summarized in this review showed that many nutritional aspects could be potential targets to induce a better control of symptoms, a deeper remission, and overall improve the quality of life of Inflammatory Bowel Disease patients.
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Affiliation(s)
- Marco Valvano
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
- Division of Gastroenterology, Galliera Hospital, 16128 Genoa, Italy;
| | - Annalisa Capannolo
- Diagnostic and Surgical Endoscopy Unit, San Salvatore Academic Hospital, 67100 L’Aquila, Italy;
| | - Nicola Cesaro
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | | | - Stefano Fabiani
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | - Sara Frassino
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | - Sabrina Monaco
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | - Marco Magistroni
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | - Angelo Viscido
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
| | - Giovanni Latella
- Gastroenterology Unit, Division of Gastroenterology, Hepatology, and Nutrition, Department of Life, Health and Environmental Sciences, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila, Italy; (N.C.); (S.F.); (S.F.); (S.M.); (M.M.); (A.V.); (G.L.)
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Rammell J, Perre D, Boylan L, Prentis J, Nesbitt C, Elmallah A, Nandhra S. The adverse impact of pre-operative anaemia on survival following major lower limb amputation. Vascular 2023; 31:379-386. [PMID: 35238256 DOI: 10.1177/17085381211065622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Approximately 5000 major lower-limb amputations (MLLA) for PAD occur per-annum in the UK with clinical outcomes being poor for this high-risk cohort of patients. Existing evidence suggests that anaemic surgical patients have an increased 30-day mortality, but this has not been explored in the context of MLLA. Recent prioritization processes suggested that MLLAs are a target area for research into outcome improvement. This cohort study evaluates the impact of anaemia on the outcome of MLLA to understand if optimization might improve outcomes. METHODS All PAD patients undergoing MLLA during 2015-2018 at a tertiary vascular centre were reviewed. Patients were stratified into groups; non-anaemia (>12 g/dL), mild-anaemia (12-10 g/dL) and severe-anaemia (<10 g/dL) by pre-operative haemoglobin (Hb). Primary outcome was overall survival by Kaplan-Meier. Secondary outcomes included length of stay (LOS), post-operative blood-transfusion, surgical-site infection (SSI) and myocardial infarction (MI). Cox-proportional-hazard and receiver-operator characteristics (ROC) analyses were conducted. RESULTS 345 patients were followed up over (mean) 23 months. 105 were non-anaemic, 111 mildly anaemic and 129 severely anaemic. Patients with severe-anaemia had a higher incidence of heart and renal failure (p = 0.003) than those with non- or mild-anaemia. Overall survival worsened significantly with increasing anaemia (p = 0.001). LOS was significantly longer in mild-anaemia which is 26 (16-43) days, (p = 0.006) and severe-anaemia of 28 days (17-40), (p < 0.001) compared to non-anaemia of 18 (10-30) days. Post-operative blood-transfusion (RBC) was required more frequently in 70.5% of severely anaemic patients (p < 0.001), compared to mildly anaemic (24.3%) and non-anaemic (7.6%) patients, with those receiving RBCs having a significantly worse survival. There was no difference in MI, SSI or wound dehiscence. Anaemia was significantly associated with mortality; (HR 1.7 (1.04-2.78), p = 0.03). A minimum-Hb of 10.4 g/L (by ROC) was identified as a cutoff Hb for an increased risk of mortality. CONCLUSION Pre-operative anaemia is associated with worse outcome following MLLA, with increasing severity of anaemia associated with increasing mortality and RBC transfusion being potentially detrimental. More work is required to prospectively evaluate this relationship in this complex and multi-morbid cohort of patients.
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Affiliation(s)
- James Rammell
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Daniel Perre
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Luke Boylan
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - James Prentis
- Department of Anaesthesia, the Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle Upon Tyne, NE7 7DN UK
| | - Craig Nesbitt
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Ahmed Elmallah
- Associate Professor of Vascular Surgery, Faculty of Medicine, El Menoufia University, El Menoufia, Egypt
| | - Sandip Nandhra
- Northern Vascular Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle-upon-Tyne, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Sugimura M, Ohtani Y, Tamai S, Kishimoto U, Ito N. Ferric derisomaltose for the treatment of iron deficiency anemia with postpartum hemorrhage: Results of a single-arm, open-label, phase 3 study in Japan. J Obstet Gynaecol Res 2023; 49:946-955. [PMID: 36653310 DOI: 10.1111/jog.15546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023]
Abstract
AIM Single-arm, open-label, phase 3 study to evaluate the efficacy and safety of ferric derisomaltose (FDI) for iron deficiency anemia (IDA) in Japanese women with postpartum hemorrhage (PPH). METHODS Postpartum women aged 20-39 years with serum ferritin <25.0 ng/ml, hemoglobin (Hb) <10.0 g/dl, and blood loss ≥500 ml within 24 h post-delivery were eligible to receive high-dose intravenous FDI. The primary endpoint was the maximum change in Hb concentration by Week 8. Key secondary endpoints included change in iron parameters and percentage of patients with a total Edinburgh Postnatal Depression Score (EPDS) ≥9. Safety assessments included treatment-emergent adverse events (TEAEs) and iron concentrations in maternal milk. RESULTS All (n = 21 [100.0%]) patients received the predetermined total iron dose by Day 8. Hb concentrations increased rapidly and significantly (p < 0.001) following FDI. Serum ferritin levels also increased rapidly and were maintained near or above the upper limit of normal reference value (250 ng/ml). Following FDI, two (9.5%) patients had a total EPDS score of ≥9. TEAEs occurred in 23 of 42 (54.8%) patients and neonates overall, including 18 of 21 (85.7%) patients and 5 of 21 (23.8%) neonates. TEAEs were mild in all adult patients and four neonates, and moderate in one neonate. Iron concentrations in maternal milk remained within normal reference values. Appropriate patient selection and patient-adjusted dosage selection facilitated safe and effective administration of high-dose (≥1000 mg) FDI. CONCLUSIONS Rapid and sustained improvements in Hb and iron stores occurred following FDI for IDA with PPH, with no new safety signals identified. CLINICAL TRIAL IDENTIFIER JapicCTI-194888.
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Affiliation(s)
- Motoi Sugimura
- Department of Obstetrics, Gynecology and Family Medicine, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Yasuyoshi Ohtani
- Research and Development Administration Department, Nippon Shinyaku Co. Ltd., Kyoto, Japan
| | - Soichiro Tamai
- Clinical Development Division, Data Science Department, Nippon Shinyaku Co. Ltd., Kyoto, Japan
| | - Umi Kishimoto
- Clinical Development Division, Clinical Development Department, Nippon Shinyaku Co. Ltd., Kyoto, Japan
| | - Naoki Ito
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
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Park JKH, Lee S, Heo CY, Jeong JH, Myung Y. The effect of immediate postoperative intravenous administration of ferric carboxymaltose after autologous free-flap breast reconstruction. Sci Rep 2022; 12:19125. [PMID: 36352090 PMCID: PMC9645745 DOI: 10.1038/s41598-022-23976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 11/08/2022] [Indexed: 11/10/2022] Open
Abstract
Intravenous ferric carboxymaltose (IV-FCM) can effectively correct perioperative anemia in patients undergoing major surgeries. However, its efficacy and side effects in patients undergoing free flap-based breast reconstruction are yet to be investigated. At our institution, from year 2020, patients with breast cancer undergoing abdominal free flap-based breast reconstruction were injected 500 mg of IV-FCM immediately post-operation. Propensity-matched 82 IV-FCM injected (study group) and 164 historical control group patients were retrospectively analyzed for transfusion rates, changes in hematological parameters, and flap or donor-site related complications. The major and minor complication rates related to the operation site were similar between the two groups. There was no significant difference in the transfusion rate between the two groups (control 29.9% vs. study 32.9%, p = 0.71). However, the total amount of transfusion required was significantly higher in the historical control group (control-53.2% 1 pack, 42.6% 2 packs, 4.3% 3 packs of RBC vs. Study-66.7% 1 pack, 33.3% 2 packs, p = 0.02) than in the study group. Additionally, the historical control group showed a significantly higher drop in red blood cell count, hemoglobin, and hematocrit levels from postoperative days 1-2 and 2-3 compared to the study group. Immediate postoperative use of IV-FCM in free flap-based breast reconstruction was well tolerated by patients and reduced overall transfusion volume.
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Affiliation(s)
- Joseph Kyu-hyung Park
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Seungjun Lee
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Chan Yeong Heo
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Jae Hoon Jeong
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
| | - Yujin Myung
- grid.412480.b0000 0004 0647 3378Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 300 Gumi-Dong, Bundang-Gu, Seongnam-Si, 463-707 Gyeonggi-Do Korea
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10
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Boots JMM, Quax RAM. High-Dose Intravenous Iron with Either Ferric Carboxymaltose or Ferric Derisomaltose: A Benefit-Risk Assessment. Drug Saf 2022; 45:1019-1036. [PMID: 36068430 PMCID: PMC9492608 DOI: 10.1007/s40264-022-01216-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/22/2022]
Abstract
The intravenous iron formulations ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) offer the possibility of administering a large amount of iron in one infusion. This results in faster correction of anemia and the formulations being better tolerated than oral iron formulations. This triad of logistic advantages, improved patient convenience, and fast correction of anemia explains the fact that intravenous iron formulations nowadays are frequently prescribed worldwide in the treatment of iron deficiency anemia. However, these formulations may result in hypophosphatemia by inducing a strong increase in active fibroblast growth factor-23 (FGF-23), a hormone that stimulates renal phosphate excretion. This effect is much more pronounced with FCM than with FDI, and therefore the risk of developing hypophosphatemia is remarkably higher with FCM than with FDI. Repeated use of FCM may result in severe osteomalacia, which is characterized by bone pain, Looser zones (pseudofractures), and low-trauma fractures. Intravenous iron preparations are also associated with other adverse effects, of which hypersensitivity reactions are the most important and are usually the result of a non-allergic complement activation on nanoparticles of free labile iron-Complement Activation-Related Pseudo-Allergy (CARPA). The risk on these hypersensitivity reactions can be reduced by choosing a slow infusion rate. Severe hypersensitivity reactions were reported in < 1% of prospective trials and the incidence seems comparable between the two formulations. A practical guideline has been developed based on baseline serum phosphate concentrations and predisposing risk factors, derived from published cases and risk factor analyses from trials, in order to establish the safe use of these formulations.
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Affiliation(s)
- Johannes M M Boots
- Department of Internal Medicine, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - Rogier A M Quax
- Department of Internal Medicine, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
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11
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Ferric Carboxymaltose Improves the Quality of Life of Patients with Inflammatory Bowel Disease and Iron Deficiency without Anaemia. J Clin Med 2022; 11:jcm11102786. [PMID: 35628914 PMCID: PMC9146412 DOI: 10.3390/jcm11102786] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 12/07/2022] Open
Abstract
Background: Iron deficiency (ID) without anaemia is a common comorbidity associated with inflammatory bowel disease (IBD) that has a negative impact on health-related quality of life (HRQoL). Methods: This multicentre, prospective, observational study examined the response to, safety of and impact on HRQoL of a single 500 mg dose of intravenous ferric carboxymaltose (FCM) in patients with IBD and ID without anaemia. The diagnostic criteria for ID were low serum ferritin (<30 µg/L in the absence of inflammatory activity or <100 µg/L with inflammation) and transferrin saturation index (TSAT) < 16%. The effect on iron levels and HRQoL, according to the health status questionnaires SF-12v2 and EQ-5D, was evaluated 1 month after FCM infusion in an outpatient setting. Results: Of the 105 patients who received FCM, 98 patients completed the study. After 1 month, a single dose of FCM significantly increased serum ferritin, serum iron and TSAT. Importantly, patients reported fewer ID symptoms and problems on all EQ-5D dimensions. They also had higher EQ-5D visual analogue scale and SF-12v2 scores after treatment. FCM had similar clinical effects on men and women and on patients with Crohn’s disease (n = 66) and ulcerative colitis (n = 32). Conclusion: A single dose of FCM rapidly restored iron parameters and significantly improved patients’ symptoms and HRQoL at 1 month after treatment.
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12
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Anker SD, Ponikowski P, Khan MS, Friede T, Jankowska EA, Fabien V, Goehring UM, Metra M, Piña IL, Coats AJS, Rosano G, Dorigotti F, Comin-Colet J, Van Veldhuisen DJ, Filippatos GS, Butler J. Responder analysis for improvement in 6-min walk test with ferric carboxymaltose in patients with heart failure with reduced ejection fraction and iron deficiency. Eur J Heart Fail 2022; 24:833-842. [PMID: 35334136 PMCID: PMC9321075 DOI: 10.1002/ejhf.2491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022] Open
Abstract
AIM Improving functional capacity is a key goal in heart failure (HF). This pooled analysis of FAIR-HF and CONFIRM-HF assessed the likelihood of improvement or deterioration in 6-min walk test (6MWT) among iron-deficient patients with chronic HF with reduced ejection fraction (HFrEF) receiving ferric carboxymaltose (FCM). METHODS AND RESULTS Data for 760 patients (FCM: n = 454; placebo: n = 306) were analysed. The proportions of patients receiving FCM or placebo who had ≥20, ≥30, and ≥40 m improvements or ≥10 m deterioration in 6MWT at 12 and 24 weeks were assessed. Patients receiving FCM experienced a mean (standard deviation) 31.1 (62.3) m improvement in 6MWT versus 0.1 (77.1) m improvement for placebo at week 12 (difference in mean changes 26.8 [16.6-37.0]). At week 12, the odds [95% confidence interval] of 6MWT improvements of ≥20 m (odds ratio 2.16 [1.57-2.96]; p < 0.0001), ≥30 m (2.00 [1.44-2.78]; p < 0.0001), and ≥40 m (2.29 [1.60-3.27]; p < 0.0001) were greater with FCM versus placebo, while the odds of a deterioration ≥10 m were reduced with FCM versus placebo (0.55 [0.38-0.80]; p = 0.0019). Among patients who experienced 6MWT improvements of ≥20, ≥30, or ≥40 m with FCM at week 12, more than 80% sustained this improvement at week 24. CONCLUSION Ferric carboxymaltose resulted in a significantly higher likelihood of improvement and a reduced likelihood of deterioration in 6MWT versus placebo among iron-deficient patients with HF. Of the patients experiencing clinically significant improvements at week 12, the majority sustained this improvement at week 24. These results are supportive of FCM to improve exercise capacity in HF.
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Affiliation(s)
- Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany.,Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Institute of Heart Diseases, University Hospital in Wroclaw, Poland
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Tim Friede
- Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Göttingen partner site, University Medical Center Göttingen, Göttingen, Germany
| | - Ewa A Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Marco Metra
- Cardiology, University and Civil Hospital, Brescia, Italy
| | - Ileana L Piña
- Central Michigan University, Mount Pleasant, MI, USA
| | | | - Giuseppe Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy
| | | | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital; IDIBELL, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Dirk J Van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gerasimos S Filippatos
- Medical School University of Cyprus, Nicosia, Cyprus.,School of Medicine of National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
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13
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Palaia I, Caruso G, Di Donato V, Perniola G, Ferrazza G, Panzini E, Scudo M, Di Pinto A, Muzii L, Panici PB. Peri-operative blood management of Jehovah's Witnesses undergoing cytoreductive surgery for advanced ovarian cancer. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2022; 20:112-119. [PMID: 35244533 PMCID: PMC8971013 DOI: 10.2451/2021.0416-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and feasibility of a peri-operative bloodless medicine and surgery (BMS) protocol in reducing severe post-operative anaemia (haemoglobin [Hb] <7 g/dL) in Jehovah's Witnesses undergoing cytoreductive surgery for advanced epithelial ovarian cancer. MATERIALS AND METHODS This was a single-institution retrospective study enrolling Jehovah's Witnesses who underwent elective bloodless surgery for advanced epithelial ovarian cancer between October 2017 and April 2020. All patients followed a standardised bloodless medicine and surgery protocol based on ferric carboxymaltose and erythropoietin if indicated. RESULTS Twenty-five patients with a mean age of 61.7 years (range, 35-80) were enrolled. Pre-operatively, ten patients (40%) were mildly anaemic (mean Hb of 10.2 g/dL [range, 9.2-11.4]) and received ferric carboxymaltose. Only four (16%) patients had severe anaemia after surgery (mean Hb of 6.1 g/dL [range, 4.1-6.9]) and received ferric carboxymaltose and erythropoietin. Compared to patients with a post-operative Hb ≥7 g/dL, those with Hb <7 g/dL had higher mean body mass index (25.8±1.8 vs 30.7±1.8 kg/m2; p<0.001), mean baseline CA125 (236.1±184.5 vs 783.7±273.5 IU/mL; p<0.001), median surgical complexity score (2 vs 10; p<0.001), and rate of post-operative complications (14.3 vs 100%; p<0.001). Moreover, these patients had a longer mean operating time (3.4±0.6 vs 5.5±0.4 h; p<0.001), duration of stay in hospital (5.5±0.7 vs 24.0±9.8 days; p<0.001), and time to adjuvant chemotherapy (27.2±2.6 vs 65.3±13.4 days; p<0.001). DISCUSSION The use of a multidisciplinary bloodless medicine and surgery protocol is safe and effective in reducing the rate of severe post-operative anaemia and improving surgical and oncological outcomes of Jehovah's Witnesses with advanced epithelial ovarian cancer. Further large-scale, prospective studies are required to confirm these data.
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Affiliation(s)
- Innocenza Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giuseppe Caruso
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Violante Di Donato
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giorgia Perniola
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Giancarlo Ferrazza
- Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Enrico Panzini
- Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Maria Scudo
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Anna Di Pinto
- Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Ludovico Muzii
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
| | - Pierluigi Benedetti Panici
- Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy
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14
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Shokri H, Ali I. Intravenous iron supplementation treats anemia and reduces blood transfusion requirements in patients undergoing coronary artery bypass grafting—A prospective randomized trial. Ann Card Anaesth 2022; 25:141-147. [PMID: 35417958 PMCID: PMC9244267 DOI: 10.4103/aca.aca_209_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Study Objective: Preoperative anemia results in two- to sixfold increased incidence of perioperative blood transfusion requirements and reduced postoperative hemoglobin (Hb) level. This prospective study was designed to investigate the effect of preoperative intravenous infusion of iron on Hb levels, blood transfusion requirements, and incidence of postoperative adverse events in patients undergoing coronary artery bypass grafting. Design: Prospective randomized trial. Setting: Academic university hospital. Patients: Eighty patients (52–67 years old) underwent coronary artery bypass grafting and received either iron therapy or saline infusion preoperatively. Interventions: Patients were randomly allocated to iron or placebo groups. In the iron group, patients received a single intravenous dose of ferric carboxymaltose (1000 mg in 100 mL saline) infused slowly over 15 min 7 days before surgery. In placebo group, patients received a single intravenous dose of saline (100 mL saline) infused slowly over 15 min 7 days before surgery. Measurements: Patients were followed up with regards to incidence of anemia, Hb level on admission, preoperatively, postoperatively, 1 week and 4 weeks after discharge, aortic cross-clamp time, the number of packed red blood cells (pRBCs) units, the percentage of reticulocytes pre–postoperatively and 1 week later, hospital stay and intensive care unit (ICU) stay length, and the incidence of postoperative complications. Main Results: Iron therapy was associated with lower incidence of anemia 4 weeks after discharge (P < 0.001). Hb level was significantly higher in the iron group compared to the placebo group preoperatively and postoperatively, and 4 weeks after discharge (P < 0.001). Iron therapy resulted in shorter hospital and ICU stay (P < 0.001) and shorter aortic cross-clamp time, reduced pRBCs requirements postoperatively. Percentage of reticulocytes was significantly higher in placebo group than in iron group postoperatively and 1 week after discharge and the incidence of postoperative complications was similar to the placebo group. Conclusions: Preoperative IV iron infusion is a safe and feasible way to manage preoperative anemia. Preoperative administration of IV iron is associated with a higher postoperative Hb level, shorter hospital and ICU stay, and reduced perioperative red blood cell transfusion requirements with insignificant difference in incidence of postoperative complications.
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15
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Sozarukova MM, Proskurnina EV, Popov AL, Kalinkin AL, Ivanov VK. New facets of nanozyme activity of ceria: lipo- and phospholipoperoxidase-like behaviour of CeO 2 nanoparticles. RSC Adv 2021; 11:35351-35360. [PMID: 35493182 PMCID: PMC9043017 DOI: 10.1039/d1ra06730c] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Cerium dioxide nanoparticles have a special place among engineered nanomaterials due to the wide range of their enzyme-like activities. They possess SOD-, catalase- and peroxidase-like properties, as well as recently discovered phosphatase-, photolyase-, phospholipase- and nuclease-like properties. Advancing biomedical applications of CeO2-based nanozymes requires an understanding of the features and mechanisms of the redox activity of CeO2 nanoparticles when entering the vascular bed, especially when interacting with lipid-protein supramolecular complexes (biomembranes and lipoproteins). In this paper, CeO2 nanoparticles are shown to possess two further types of nanozyme activity, namely lipo- and phospholipoperoxidase-like activities. Compared to a strong blood prooxidant, hemoglobin, CeO2 nanoparticles act as a mild oxidising agent, since they exhibit a 106 times lower, and 20 times lower, prooxidant capacity towards linoleic acid and phosphatidylcholine hydroperoxides, respectively. Compared to the widespread pharmacological preparation of iron, Fe(iii) carboxymaltose (antianemic preparation Ferinject®), the prooxidant capacity of CeO2 nanoparticles towards lipid and phospholipid substrates has been shown to be 102 times lower, and 4 times higher, respectively. The data obtained on the mechanism of the interaction of nanodisperse CeO2 with the main components of biological membranes, lipids and phospholipids enable the substantial expansion of the scope of biomedical applications of CeO2 nanozymes. CeO2 nanoparticles were shown to possess two novel types of enzyme-like activity, namely lipoperoxidase and phospholipoperoxidase activity.![]()
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Affiliation(s)
- Madina M Sozarukova
- Kurnakov Institute of General and Inorganic Chemistry, Russian Academy of Sciences Russian Federation
| | | | - Anton L Popov
- Kurnakov Institute of General and Inorganic Chemistry, Russian Academy of Sciences Russian Federation .,Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences Russian Federation
| | - Alexander L Kalinkin
- Medical Research and Educational Center, Lomonosov Moscow State University Russian Federation
| | - Vladimir K Ivanov
- Kurnakov Institute of General and Inorganic Chemistry, Russian Academy of Sciences Russian Federation .,National Research University Higher School of Economics Russian Federation
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16
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Thin TN, Tan BPY, Sim EY, Shum KL, Chan HSP, Abdullah HR. Preoperative Single-Dose Intravenous Iron Formulation to Reduce Postsurgical Complications in Patients Undergoing Major Abdominal Surgery: A Randomized Control Trial Feasibility Study (PIRCAS Trial Pilot). Cureus 2021; 13:e17357. [PMID: 34567897 PMCID: PMC8452824 DOI: 10.7759/cureus.17357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background Preoperative anemia is associated with an increased need for blood transfusion, complications, and prolonged hospital stay. Iron deficiency anemia (IDA) may be treated with oral or intravenous (IV) iron. IV iron repletes iron stores more rapidly. Its impact on perioperative blood transfusion, postoperative complications, patients’ recovery, and long-term quality of life is unclear. Newer agents, such as ferric carboxymaltose (FCM), are costly but have higher maximum approved doses and a very low incidence of anaphylactic-type reactions. This study aims to explore the feasibility of a randomized control trial to compare the preoperative treatment of IDA with IV FCM versus oral ferrous fumarate, in patients undergoing elective major abdominal surgery. Experimental design This is an open-label pilot randomized controlled trial. A total of 30 adults with IDA scheduled for elective major abdominal surgery were recruited for the study. They were randomized into two groups to receive either oral iron or IV FCM. Primary outcomes are defined as the time from enrollment to study drug administration, recruitment rate, and follow-up rate up to three months. Secondary outcomes are hemoglobin rise from recruitment to surgery, perioperative blood transfusion, postoperative complications, EQ-5D-3L scores at baseline, and three months and adverse events related to IV FCM therapy. Results All patients received study drugs within five days of enrollment; 30 patients were recruited within four months, 15 patients in each group. Two in each group were withdrawn for surgery postponement. All patients were followed up for three months and there was no crossover of patients. Per protocol, analysis was performed. No severe adverse events related to IV FCM therapy occurred. Both groups had similar baseline characteristics, similar hemoglobin rise from enrollment to the day of surgery [0.2 (+1.6) g/dL in the FCM group and 0.8 (+0.7) g/dL in the Oral Iron group, p=0.3] and similar mean units of perioperative blood transfused (recruitment to discharge) per patient [1.3 (+ 2.1) in the FCM group and 0.9 (+1.3) in the Oral Iron group, p=0.6]. Postoperatively, there was a similar hospital length of stay [11.5 (+13.6 days) in the FCM group and 9.0 (+9.8 days) in the Oral Iron group, p=0.6]; there were similar postoperative complications as reflected by the average Comprehensive Complication Index [12.8 (+19.6) in the FCM group and 22.6 (+30.7) in the Oral Iron group, p=0.3]; similar postoperative health-related quality of life as reflected by mean EQ-5D-3L scores at one month [70.4 (+21.8) in the FCM group and 84.5 (+12.1) in the Oral Iron group] and three months [80.0 (+18.4) in the FCM group and 85.9 (+10.7) in the Oral Iron group]. Conclusions A full-scale randomized controlled trial to evaluate the effectiveness of preoperative IV FCM compared to oral iron in patients with IDA undergoing major abdominal surgery is feasible.
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Affiliation(s)
- Thiri Naing Thin
- Department of Anesthesiology, Singapore General Hospital, Singapore, SGP
| | - Brenda Pei Yi Tan
- Department of Anesthesiology, Singapore General Hospital, Singapore, SGP
| | - Eileen Y Sim
- Department of Anesthesiology, Singapore General Hospital, Singapore, SGP
| | - Koin Lon Shum
- Department of Internal Medicine, Singapore General Hospital, Singapore, SGP
| | - Hazel Su Pin Chan
- Department of Anesthesiology, Singapore General Hospital, Singapore, SGP
| | - Hairil Rizal Abdullah
- Department of Anesthesiology, Singapore General Hospital, Singapore, SGP.,Anesthesiology, Duke-National University of Singapore (NUS) Medical School, Singapore, SGP
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17
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Kaur R, Kant S, Haldar P, Ahamed F, Singh A, Dwarakanathan V, Malhotra S, Yadav K. Single Dose of Intravenous Ferric Carboxymaltose Prevents Anemia for 6 Months among Moderately or Severely Anemic Postpartum Women: A Case Study from India. Curr Dev Nutr 2021; 5:nzab078. [PMID: 34268465 PMCID: PMC8275451 DOI: 10.1093/cdn/nzab078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 05/05/2021] [Indexed: 01/11/2023] Open
Abstract
The effectiveness of intravenous ferric carboxymaltose (FCM) in quickly increasing normal hemoglobin concentration and replenishing body iron reserves up to 6-12 wk is known; however, its long-term effectiveness is unknown. In this study conducted in northern India during August 2018 to February 2019, 100 postpartum women within 48 h of delivery with a hemoglobin concentration between 5.0 and 9.9 g/dL were included. A single dose of intravenous FCM was administered. The hemoglobin and serum ferritin concentrations were measured at baseline and at 6 mo. Out of 100 women recruited, 57 (57%) returned for the follow-up visit at 6 mo. The mean (± SD) hemoglobin and serum ferritin concentrations at baseline were 8.6 ± 1.1 g/dL and 15.8 ± 17.2 ng/mL, respectively, and at 6 months were 12.5 ± 1.2 g/dL and 72.0 ± 52.0 ng/mL, respectively. The mean increase in hemoglobin concentration was 3.9 (95% CI: 3.5, 4.3) g/dL (P < 0.001) and for serum ferritin was 53.8 (95% CI: 41.8, 65.8) ng/mL (P < 0.001). The study was registered prospectively in the Clinical Trials Registry-India (CTRI) as CTRI/2018/06/014332.
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Affiliation(s)
- Ravneet Kaur
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Farhad Ahamed
- Department of Community and Family Medicine, AIIMS, Kalyani, West Bengal, India
| | | | - Vignesh Dwarakanathan
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil Yadav
- Centre for Community Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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18
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Assouline B, Benoliel A, Zamberg I, Legouis D, Delhumeau C, Favre M, Andrès A, Toso C, Samii K, Schiffer E. Intravenous iron supplementation after liver surgery: Impact on anemia, iron, and hepcidin levels-a randomized controlled trial. Surgery 2021; 170:813-821. [PMID: 33888314 DOI: 10.1016/j.surg.2021.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia is a recognized risk factor for perioperative related morbidity and mortality and is frequently reported in liver surgeries with an estimated incidence of 32%. We aim to assess the impact of intravenous iron administration in the immediate postoperative period on anemia and iron status as well as to determine the kinetics of hepcidin after liver surgery. METHODS The HepciFer trial, a randomized controlled trial, included 50 patients undergoing liver surgery. In accordance with the randomization process, patients received either ferric carboxymaltose (15 mg/kg, maximum 1 g) or placebo 4 hours after surgery. RESULTS The mean hemoglobin level, 7 days after surgery, did not differ significantly between the intervention and control group (11.1 ± 1.8 g/dL and 10.4 ± 1.6 g/dL, respectively) with a mean difference of +0.7 g/dL ([95% confidence interval, -0.3 to +1.7], P = .173). Within patients receiving intravenous iron supplementation, none presented biological signs of functional iron deficiency. Hepcidin levels remained significantly higher during the observation period in the intervention group. Inflammatory biomarkers, red blood cells transfusion rate and hospital duration of stay were similar between groups. CONCLUSION Intravenous ferric carboxymaltose administration did not result in a significant increase of hemoglobin levels 7 days after surgery. However, this study suggests that intravenous iron supplementation in the immediate postoperative settings prevents functional iron deficiency. Intravenous iron supplementation overcame the hepcidin-mediated blockade of iron absorption and should be considered as the preferred route of administration in the postoperative period.
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Affiliation(s)
- Benjamin Assouline
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Alan Benoliel
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Ido Zamberg
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. https://twitter.com/IdoZamberg
| | - David Legouis
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Cecile Delhumeau
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mathieu Favre
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Axel Andrès
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christian Toso
- Division of Digestive Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Kaveh Samii
- Division of Hematology, Department of Oncology, Geneva University Hospitals, Geneva, Switzerland
| | - Eduardo Schiffer
- Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland; Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
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19
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Efficacy and Safety of Intravenous Ferric Carboxymaltose in Patients with Postoperative Anemia Following Same-Day Bilateral Total Knee Arthroplasty: A Randomized Controlled Trial. J Clin Med 2021; 10:jcm10071457. [PMID: 33918110 PMCID: PMC8036569 DOI: 10.3390/jcm10071457] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 01/28/2023] Open
Abstract
(1) Background: The purpose of this study was to evaluate the efficacy and safety of intravenous (IV) ferric carboxymaltose (FCM) to treat acute postoperative anemia following same-day bilateral total knee arthroplasty (TKA). (2) Methods: A total of 118 patients who underwent same-day bilateral TKA were randomly assigned to two groups: an FCM group (FCM infusion, 58 patients) and a Control group (placebo with normal saline, 60 patients). The primary endpoint was the number of responders with a Hb increase of two or more points by the second postoperative week. The secondary endpoints were Hb level, iron metabolism variables and blood transfusion rate at 2, 6 and 12 weeks after surgery. (3) Results: The FCM group had more Hb responders than the Control group (62.1% vs. 31.6%, p < 0.001). The Hb level was significantly higher in the FCM group during 12 weeks after surgery (all p < 0.05). Ferritin, iron and transferrin saturation levels were significantly higher in the FCM group from 2 to 12 weeks postoperatively (all p < 0.05). There was no difference in transfusion rate after surgery (p > 0.05). (4) Conclusion: In patients with postoperative anemia after same-day bilateral TKA, IV FCM infusion significantly improved Hb response two weeks after surgery without severe adverse events compared to placebo. In contrast, transfusion rate and various parameters of quality of life assessment up to 12 weeks did not vary between these groups. Level of evidence: Level I.
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Cirillo L, Somma C, Allinovi M, Bagalà A, Ferro G, Di Marcantonio E, Bellelli S, Dallari LA, Ballo P, Dattolo PC. Ferric carboxymaltose vs. ferrous sulfate for the treatment of anemia in advanced chronic kidney disease: an observational retrospective study and cost analysis. Sci Rep 2021; 11:7463. [PMID: 33811227 PMCID: PMC8018957 DOI: 10.1038/s41598-021-86769-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 03/15/2021] [Indexed: 01/02/2023] Open
Abstract
In non-dialysis-dependent chronic kidney disease (NDD-CKD), erythropoiesis-stimulating agents (ESAs) and iron supplementation are essential for anemia management. Ferric carboxymaltose (FCM) is a relatively novel intravenous iron formulation used in different clinical settings, although scarce data exist in NDD-CKD patients. Primary objective of this study was to retrospectively evaluate the efficacy of FCM compared with oral ferrous sulfate for the treatment of iron-deficiency anemia in a cohort of NDD-CKD patients, considering also the treatment costs. This was a monocentric, retrospective observational study reviewing 349 NDD-CKD patients attending an outpatient clinic between June 2013 and December 2016. Patients were treated by either FCM intravenous infusion or oral ferrous sulfate. We collected serum values of hemoglobin, ferritin and transferrin saturation (TSAT) and ESAs doses at 12 and 18 months. The costs related to both treatments were also analysed. 239 patients were treated with FCM intravenous infusion and 110 patients with oral ferrous sulfate. The two groups were not statistically different for age, BMI and eGFR values. At 18 months, hemoglobin, serum ferritin and TSAT values increased significantly from baseline in the FCM group, compared with the ferrous sulfate group. ESAs dose and rate of infusion decreased only in the FCM group. At 18 months, the treatment costs, analysed per week, was higher in the ferrous sulfate group, compared with the FCM group, and this was mostly due to a reduction in ESAs prescription in the FCM group. Routine intravenous FCM treatment in an outpatient clinic of NDD-CKD patients results in better correction of iron-deficiency anemia when compared to ferrous sulfate. In addition to this, treating NDD-CKD patients with FCM leads to a significant reduction of the treatment costs by reducing ESAs use.
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Affiliation(s)
- Luigi Cirillo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Chiara Somma
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Marco Allinovi
- Nephrology, Dialysis and Transplant Unit, Careggi University Hospital, Florence, Italy
| | - Alfredo Bagalà
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Giuseppe Ferro
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Elio Di Marcantonio
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Stefania Bellelli
- Health Technology Assessment and Management (HTAM) Research Area, IRES Piemonte, Torino, Italy
| | - Lorenzo Antonio Dallari
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Piercarlo Ballo
- Cardiology Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy
| | - Pietro Claudio Dattolo
- Nephrology and Dialysis Unit, Santa Maria Annunziata Hospital, Bagno a Ripoli, Florence, Italy.
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Tagliafico L, Parodi MN, Odetti P, Nencioni A, Monacelli F. Safety and tolerability of intravenous ferric carboxymaltose in the oldest old patients: a prospective cohort study in a University Italian Geriatrics Department. JOURNAL OF GERONTOLOGY AND GERIATRICS 2021. [DOI: 10.36150/2499-6564-n001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Predictors for blood loss and transfusion frequency to guide blood saving programs in primary knee- and hip-arthroplasty. Sci Rep 2021; 11:4386. [PMID: 33623079 PMCID: PMC7902666 DOI: 10.1038/s41598-021-82779-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/08/2021] [Indexed: 12/14/2022] Open
Abstract
Endoprosthetic surgery can lead to relevant blood loss resulting in red blood cell (RBC) transfusions. This study aimed to identify risk factors for blood loss and RBC transfusion that enable the prediction of an individualized transfusion probability to guide preoperative RBC provision and blood saving programs. A retrospective analysis of patients who underwent primary hip or knee arthroplasty was performed. Risk factors for blood loss and transfusions were identified and transfusion probabilities computed. The number needed to treat (NNT) of a potential correction of preoperative anemia with iron substitution for the prevention of RBC transfusion was calculated. A total of 308 patients were included, of whom 12 (3.9%) received RBC transfusions. Factors influencing the maximum hemoglobin drop were the use of drain, tranexamic acid, duration of surgery, anticoagulation, BMI, ASA status and mechanical heart valves. In multivariate analysis, the use of a drain, low preoperative Hb and mechanical heart valves were predictors for RBC transfusions. The transfusion probability of patients with a hemoglobin of 9.0–10.0 g/dL, 10.0–11.0 g/dL, 11.0–12.0 g/dL and 12.0–13.0 g/dL was 100%, 33.3%, 10% and 5.6%, and the NNT 1.5, 4.3, 22.7 and 17.3, while it was 100%, 50%, 25% and 14.3% with a NNT of 2.0, 4.0, 9.3 and 7.0 in patients with a drain, respectively. Preoperative anemia and the insertion of drains are more predictive for RBC transfusions than the use of tranexamic acid. Based on this, a personalized transfusion probability can be computed, that may help to identify patients who could benefit from blood saving programs.
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Nanomedicines accessible in the market for clinical interventions. J Control Release 2021; 330:372-397. [DOI: 10.1016/j.jconrel.2020.12.034] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023]
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Man Y, Xu T, Adhikari B, Zhou C, Wang Y, Wang B. Iron supplementation and iron-fortified foods: a review. Crit Rev Food Sci Nutr 2021; 62:4504-4525. [PMID: 33506686 DOI: 10.1080/10408398.2021.1876623] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
About one-third of the world population is suffering from iron deficiency. Delivery of iron through diet is a practical, economical, and sustainable approach. Clinical studies have shown that the consumption of iron-fortified foods is one of the most effective methods for the prevention of iron deficiency. However, supplementing iron through diet can cause undesirable side-effects. Thus, it is essential to develop new iron-rich ingredients, iron-fortified products with high bioavailability, better stability, and lower cost. It is also essential to develop newer processing technologies for more effective fortification. This review compared the iron supplementation strategies used to treat the highly iron-deficient population and the general public. We also reviewed the efficacy of functional (iron-rich) ingredients that can be incorporated into food materials to produce iron-fortified foods. The most commonly available foods, such as cereals, bakery products, dairy products, beverages, and condiments are still the best vehicles for iron fortification and delivery.Scope of reviewThe manuscript aims at providing a comprehensive review of the latest publications that cover three aspects: administration routes for iron supplementation, iron-rich ingredients used for iron supplementation, and iron-fortified foods.
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Affiliation(s)
- Yaxing Man
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, PR China
| | - Tiantian Xu
- Guangdong Provincial Key Laboratory of Veterinary Pharmaceutics Development and Safety Evaluation, South China Agricultural University, Guangzhou, PR China
| | - Benu Adhikari
- School of Science, RMIT University, Melbourne, Australia
| | - Cunshan Zhou
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, PR China
| | - Yuchuan Wang
- School of Food Engineering, Jiangnan University, Wuxi, PR China
| | - Bo Wang
- School of Food and Biological Engineering, Jiangsu University, Zhenjiang, PR China
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TEKİN M, UZUN ND, UZUN F. Evaluation of ferric carboxymaltose treatment efficacy in women with postpartum iron deficiency anemia. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.800829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Crowley CM, McMahon G, Desmond J, Imcha M. Preventing skin staining: an effective iron infusion protocol. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 32162854 DOI: 10.1108/ijhcqa-10-2019-0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To implement a safe and effective intravenous iron infusion protocol to prevent skin staining. DESIGN/METHODOLOGY/APPROACH Mixed methods approach was utilised including education, auditing, self-reported survey, patient information leaflet and patient feedback. In total 25 healthcare professionals completed the survey and 15 patients provided feedback. FINDINGS No skin staining or severe adverse reactions were observed over eight weeks. Audit results found 53 per cent of staff were compliant with the recommended IV iron infusion protocol and 46 per cent informed patients of skin staining risk. Self-report surveys indicated 92 per cent flushed the cannula with sodium chloride before starting the infusion, 88 per cent flushed the cannula after the infusion and 76 per cent informed patients of skin staining risk. Patient feedback was largely positive and constructive. RESEARCH LIMITATIONS Limitations include self-reported bias, short audit time interval, missing data and discrepancy between audit and survey results. ORIGINALITY/VALUE This quality improvement project was developed following two skin staining incidences at our maternity hospital. Although rare, skin staining after intravenous iron infusion is potentially permanent and may be distressing for some patients. Intravenous iron is considered safe and effective to treat anaemia during pregnancy and is often prescribed for this patient cohort. To avoid medicolegal action and patient dissatisfaction, it is essential that patients are informed of potential skin staining and an evidence-based administration protocol is utilised.
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Affiliation(s)
| | - Gabriela McMahon
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Joanna Desmond
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
| | - Mendinaro Imcha
- Department of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Limerick, Ireland
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Schaefer B, Tobiasch M, Viveiros A, Tilg H, Kennedy NA, Wolf M, Zoller H. Hypophosphataemia after treatment of iron deficiency with intravenous ferric carboxymaltose or iron isomaltoside-a systematic review and meta-analysis. Br J Clin Pharmacol 2020; 87:2256-2273. [PMID: 33188534 PMCID: PMC8247006 DOI: 10.1111/bcp.14643] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/27/2020] [Accepted: 11/03/2020] [Indexed: 12/21/2022] Open
Abstract
Aims Hypophosphataemia is an increasingly recognized side‐effect of ferric carboxymaltose (FCM) and possibly iron isomaltoside/ferric derisomaltose (IIM), which are used to treat iron deficiency. The aim of this study was to determine frequency, severity, duration and risk factors of incident hypophosphataemia after treatment with FCM and IIM. Methods A systematic literature search for articles indexed in EMBASE, PubMed and Web of Science in years 2005–2020 was carried out using the search terms ‘ferric carboxymaltose’ OR ‘iron isomaltoside’. Prospective clinical trials reporting outcomes on hypophosphataemia rate, mean nadir serum phosphate and/or change in mean serum phosphate from baseline were selected. Hypophosphataemia rate and severity were compared for studies on IIM vs. FCM after stratification for chronic kidney disease. Meta‐regression analysis was used to investigate risk factors for hypophosphataemia. Results Across the 42 clinical trials included in the meta‐analysis, FCM induced a significantly higher incidence of hypophosphataemia than IIM (47%, 95% CI 36–58% vs. 4%, 95% CI 2–5%), and significantly greater mean decreases in serum phosphate (0.40 vs. 0.06 mmol/L). Hypophosphataemia persisted at the end of the study periods (maximum 3 months) in up to 45% of patients treated with FCM. Meta‐regression analysis identified low baseline serum ferritin and transferrin saturation, and normal kidney function as significant predictors of hypophosphataemia. Conclusion FCM is associated with a high risk of hypophosphataemia, which does not resolve for at least 3 months in a large proportion of affected patients. More severe iron deficiency and normal kidney function are risk factors for hypophosphataemia.
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Affiliation(s)
- Benedikt Schaefer
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory of Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Moritz Tobiasch
- Department of Medicine, University Teaching Hospital of Hall in Tirol, Hall, Austria
| | - André Viveiros
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory of Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Tilg
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nicholas A Kennedy
- IBD Pharmacogenetics, University of Exeter, Exeter, UK.,Gastrointestinal Unit, Western General Hospital, Edinburgh, UK
| | - Myles Wolf
- Department of Medicine, Division of Nephrology, and Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria.,Christian Doppler Laboratory of Iron and Phosphate Biology, Medical University of Innsbruck, Innsbruck, Austria
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Efficacy and safety of intravenous ferric carboxymaltose compared with oral iron for the treatment of iron deficiency anaemia in women after childbirth in Tanzania: a parallel-group, open-label, randomised controlled phase 3 trial. LANCET GLOBAL HEALTH 2020; 9:e189-e198. [PMID: 33245866 DOI: 10.1016/s2214-109x(20)30448-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Iron deficiency anaemia is of major concern in low-income settings, especially for women of childbearing age. Oral iron substitution efficacy is limited by poor compliance and iron depletion severity. We aimed to assess the efficacy and safety of intravenous ferric carboxymaltose versus oral iron substitution following childbirth in women with iron deficiency anaemia in Tanzania. METHODS This parallel-group, open-label, randomised controlled phase 3 trial was done at Bagamoyo District Hospital and Mwananyamala Hospital, Tanzania. Eligible participants were close to delivery and had iron deficiency anaemia defined as a haemoglobin concentration of less than 110 g/L and a ferritin concentration of less than 50 μg/L measured within 14 days before childbirth. Participants were randomly assigned 1:1 to receive intravenous ferric carboxymaltose or oral iron, stratified by haemoglobin concentration and site. Intravenous ferric carboxymaltose was administered at a dose determined by the haemoglobin concentration and bodyweight (bodyweight 35 kg to <70 kg and haemoglobin ≥100 g/L: 1000 mg in one dose; bodyweight 35 kg to <70 kg and haemoglobin <100 g/L, or bodyweight ≥70 kg and haemoglobin ≥100 g/L: 1500 mg in two doses at least 7 days apart; bodyweight ≥70 kg and haemoglobin <100 g/L: 2000 mg in two doses at least 7 days apart). Oral iron treatment consisted of three dried ferrous sulphate tablets of 200 mg containing 60 mg of elementary iron and 5 mg of folic acid every morning. Oral treatment was to be taken for 3 months after haemoglobin normalisation. The primary outcome was haemoglobin normalisation (>115 g/L) at 6 weeks. Follow-up visits were at 6 weeks, and 3, 6, and 12 months. Analyses were done in the modified intention-to-treat population of participants who had a 6-week haemoglobin concentration result, using logistic and linear regression models for binary and continuous outcomes, adjusted for baseline haemoglobin concentration and site. This trial is registered with ClinicalTrials.gov, NCT02541708. FINDINGS Between Oct 8, 2015, and March 14, 2017, 533 individuals were screened and 230 were enrolled and randomly assigned to a study group (114 to intravenous iron, 116 to oral iron). At 6 weeks, 94 (82%) participants in the intravenous iron group and 92 (79%) in the oral iron group were assessed for the primary outcome. 75 (80%) participants in the intravenous iron group and 47 (51%) in the oral iron group had normalised haemoglobin (odds ratio 4·65, 95% CI 2·33-9·27). There were two mild to moderate infusion-related adverse events; and five serious adverse events (three in the intravenous iron group, two in the oral iron group), unrelated to the study medication. INTERPRETATION Intravenous iron substitution with ferric carboxymaltose was safe and yielded a better haemoglobin response than oral iron. To our knowledge, this is the first study to provide evidence of the benefits and safety of intravenous iron substitution in a low-income setting. FUNDING Vifor Pharma, R Geigy-Stiftung, Freiwillige Akademische Gesellschaft, and Swiss Tropical and Public Health Institute.
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Jacob J, Miró Ò, Ferre C, Borraz-Ordás C, Llopis-García G, Comabella R, Fernández-Cañadas JM, Mercado A, Roset A, Richard-Espiga F, Valero-Domènech A, Martínez-Gimeno JL, Martín-Sánchez FJ, Llorens P, Berrocal-Gil P, Pérez-Durá MJ, Álvarez-Pérez JM, López-Díez P, Herrero-Puente P, Comín-Colet J. Iron deficiency and safety of ferric carboxymaltose in patients with acute heart failure. AHF-ID study. Int J Clin Pract 2020; 74:e13584. [PMID: 32533907 DOI: 10.1111/ijcp.13584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 06/08/2020] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION The presence of iron deficiency (ID) in patients with acute heart failure (AHF) is high. There are few studies on the characteristics of these patients and the safety of ferric carboxymaltose administration (FCM). OBJECTIVE Study the differences among patients with AHF based on the presence and type of ID as well as the safety of FCM administration in these patients. METHOD The AHF-ID study is a multicentre, analytical, prospective follow-up cohort including patients admitted to six Spanish hospitals for AHF. ID was defined as serum ferritin <100 μg/L (group A) or ferritin 100-299 μg/L with a TSAT <20% (group B). In cases receiving FCM the appearance of adverse events was analysed. Adjusted Cox regression was used to determine the association with 30-days reattendance for AHF after discharge. RESULTS A total of 221 patients were recruited; 191 (86.4%) presented ID, 121 (63.4%) group A and 70 (36.6%) group B. There were scarce differences between the groups analysed. No differences were found in 30-days reattendance for AHF. FCM was administered to 158 (71.5%) patients, with 8 (5.1%) presenting adverse events, the most frequent being digestive alterations. Treatment was not discontinued in any case. CONCLUSIONS There are scarce differences between the presence and the type of ID in patients with AHF. The administration of FCM in patients with ID and AHF is safe.
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Affiliation(s)
- Javier Jacob
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Òscar Miró
- Emergency Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
- Medical School, University of Barcelona, Spain
| | - Carles Ferre
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Guillermo Llopis-García
- Emergency Department, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa Comabella
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Amparo Mercado
- Emergency Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Alex Roset
- Emergency Department and Short Stay Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | - Pere Llorens
- Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain
| | - Pablo Berrocal-Gil
- Internal Medicine, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | | | - Pilar López-Díez
- Emergency Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
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The Impact of Iron Supplementation for Treating Anemia in Patients with Chronic Kidney Disease: Results from Pairwise and Network Meta-Analyses of Randomized Controlled Trials. Pharmaceuticals (Basel) 2020; 13:ph13050085. [PMID: 32365757 PMCID: PMC7281268 DOI: 10.3390/ph13050085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 12/11/2022] Open
Abstract
After relative erythropoietin deficiency, iron deficiency is the second most important contributing factor for anemia in chronic kidney disease (CKD) patients. Iron supplementation is a crucial part of the treatment of anemia in CKD patients, and intravenous (IV) iron supplementation is considered to be superior to per os (PO) iron supplementation. The differences between the available formulations are poorly characterized. This report presents results from pairwise and network meta-analyses carried out after a comprehensive search in sources of published and unpublished studies, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations (International prospective register of systematic reviews PROSPERO reference ID: CRD42020148155). Meta-analytic calculations were performed for the outcome of non-response to iron supplementation (i.e., hemoglobin (Hgb) increase of <0.5–1.0 g/dL, or initiation/intensification of erythropoiesis-stimulating agent (ESA) therapy, or increase/change of iron supplement, or requirements of blood transfusion). A total of 34 randomized controlled trials (RCT) were identified, providing numerical data for analyses covering 93.7% (n = 10.097) of the total study population. At the network level, iron supplementation seems to have a more protective effect against the outcome of non-response before the start of dialysis than once dialysis is initiated, and some preparations seem to be more potent (e.g., ferumoxytol, ferric carboxymaltose), compared to the rest of iron supplements assessed (surface under the cumulative ranking area (SUCRA) > 0.8). This study provides parameters for adequately following-up patients requiring iron supplementation, by presenting the most performing preparations, and, indirectly, by making it possible to identify good responders among all patients treated with these medicines.
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The effect of iron carboxymaltose treatment on quality of life in women with iron deficiency. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.650854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Drexler C, Macher S, Lindenau I, Holter M, Moritz M, Stojakovic T, Pieber TR, Schlenke P, Amrein K. High-dose intravenous versus oral iron in blood donors with iron deficiency: The IronWoMan randomized, controlled clinical trial. Clin Nutr 2020; 39:737-745. [DOI: 10.1016/j.clnu.2019.03.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/01/2019] [Accepted: 03/18/2019] [Indexed: 01/01/2023]
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Koo CH, Shin HJ, Cho H, Ryu JH. The Effect of Perioperative Intravenous Iron on Hemoglobin in Surgical Patients: A Meta-Analysis. J Surg Res 2020; 246:42-51. [DOI: 10.1016/j.jss.2019.08.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/26/2019] [Accepted: 08/29/2019] [Indexed: 12/26/2022]
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Ifie E, Oyibo S, Joshi H, Akintade O. Symptomatic hypophosphataemia after intravenous iron therapy: an underrated adverse reaction. Endocrinol Diabetes Metab Case Rep 2019; 2019. [PMID: 31385673 PMCID: PMC6689119 DOI: 10.1530/edm-19-0065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Iron (ferric carboxymaltose) infusion therapy is used to treat severe iron deficiency which is not responding to the first-line oral iron therapy. However, it can also cause severe renal wasting of phosphate resulting in severe hypophosphataemia in some patients. Despite the growing number of case reports, this side effect is not well known to healthcare professionals. The product labelling information sheet does mention that hypophosphataemia can be a side effect, but also says that this side effect is usually transient and asymptomatic. We report a challenging case of a patient who developed severe, symptomatic and prolonged hypophosphataemia after an intravenous iron infusion for severe iron deficiency.
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Affiliation(s)
- Eseoghene Ifie
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Samson Oyibo
- Department of Endocrinology, Peterborough City Hospital, Peterborough, UK
| | - Hareesh Joshi
- Department of Endocrinology, Peterborough City Hospital, Peterborough, UK
| | - Olugbenro Akintade
- Department of Elderly Care Medicine, Peterborough City Hospital, Peterborough, UK
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Rocha BML, Cunha GJL, Menezes Falcão LF. The Burden of Iron Deficiency in Heart Failure: Therapeutic Approach. J Am Coll Cardiol 2019; 71:782-793. [PMID: 29447741 DOI: 10.1016/j.jacc.2017.12.027] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 12/18/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022]
Abstract
Heart failure (HF) is highlighted by its burdening symptom-limited exercise capacity and recurrent hospitalizations. Despite substantial advances regarding disease-modifying drugs in HF with reduced ejection fraction, additional therapeutic strategies to improve quality of life are invaluable. Currently, iron deficiency (ID) is overwhelmingly recognized in over 30% to 50% of patients with stable chronic HF, which worsens prognosis. The established pathophysiological mechanisms of progressive HF may be intertwined with increasing myocardial iron scarcity, wherein one begets the other. Most importantly, ID constitutes a novel target for symptom relief in carefully selected patients. In this regard, intravenous iron may be a safe and efficacious intervention, potentially reducing HF hospitalizations. We discuss the evidence and gaps in knowledge concerning iron therapy in HF and propose a practical, comprehensive, clinically oriented algorithm for timely adequate iron replenishment in different clinical scenarios. Finally, we further debate imperative decision-making before intervention and the drawbacks of such a strategy.
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Affiliation(s)
| | | | - Luiz F Menezes Falcão
- Department of Internal Medicine, Hospital Santa Maria/CHLN, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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Pollock RF, Muduma G. A systematic literature review and indirect comparison of iron isomaltoside and ferric carboxymaltose in iron deficiency anemia after failure or intolerance of oral iron treatment. Expert Rev Hematol 2019; 12:129-136. [PMID: 30689458 DOI: 10.1080/17474086.2019.1575202] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The efficacy of oral iron in treating iron deficiency anemia (IDA) can be limited by poor gastrointestinal (GI) absorption and adverse GI symptoms; intravenous (IV) iron is a well-established alternative. The present study compared the efficacy of two IV iron formulations in patients with IDA: iron isomaltoside (IIM) and ferric carboxymaltose (FCM). METHODS A systematic literature review (SLR) was conducted to identify randomized controlled trials (RCTs) of IIM and FCM in patients with IDA. An adjusted indirect treatment comparison (ITC) of IIM and FCM was then conducted to evaluate differences in change from baseline hemoglobin and the proportion of patients achieving a clinically-relevant response. RESULTS The SLR identified no completed RCTs of IIM versus FCM, 5 RCTs of IIM (4 versus oral iron and 1 versus iron sucrose), and 14 RCTs of FCM (11 versus oral iron and 3 versus iron sucrose). In an ITC via iron sucrose, IIM resulted in a significantly larger increase from baseline hemoglobin with a mean difference of +0.249 g/dL with IIM relative to FCM, but there was no significant difference in the proportion of patients with a clinically-relevant response. CONCLUSIONS IIM resulted in a larger increase from baseline hemoglobin than FCM in patients with IDA, but with no difference in the proportion of patients responding. Studies comparing IIM and FCM directly would be needed to confirm these findings.
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Affiliation(s)
| | - Gorden Muduma
- b International Market Access , Pharmacosmos A/S , Holbæk , Denmark
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Xu H, Duan Y, Yuan X, Wu H, Sun H, Ji H. Intravenous Iron Versus Placebo in the Management of Postoperative Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial. J Cardiothorac Vasc Anesth 2019; 33:2941-2948. [PMID: 30930140 DOI: 10.1053/j.jvca.2019.01.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the efficacy of intravenous iron versus placebo to correct postoperative functional iron deficiency anemia in patients undergoing cardiac valvular surgery. DESIGN A prospective, single-blinded, randomized controlled study. SETTING National Center for Cardiovascular Diseases and a university hospital. PARTICIPANTS The study comprised 150 patients with postoperative functional iron deficiency anemia after cardiac valvular surgery. INTERVENTIONS The patients were randomly assigned (1:1) to either the treatment (intravenous iron) group or the control (placebo) group. MEASUREMENTS AND MAIN RESULTS The hemoglobin and ferritin concentrations and postoperative adverse events were collected and compared between the 2 groups. The hemoglobin concentration and the proportion of patients who had their anemia corrected or achieved hemoglobin increments of >20 g/L in the intravenous iron group were significantly higher than that in the placebo group at postoperative day 14 (p = 0.023, p = 0.037, and p = 0.001), whereas there was no statistical difference at postoperative day 7. The ferritin concentration was substantially higher at postoperative day 7 and postoperative day 14 in the intravenous iron group compared with the placebo group (both p < 0.001). There were no significant differences in rates of death, blood tranfusion, antibiotic upgrade, ventilator time >24 hours, postoperative hospital stay >10 days, poor wound healing, and perivalvular leakage between the 2 groups. CONCLUSIONS Intravenous iron could significantly increase the hemoglobin level in patients with postoperative functional iron deficiency anemia at postoperative day 14. However, there is no difference in blood transfusion requirements or postoperative adverse outcomes between the 2 groups.
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Affiliation(s)
- Haitao Xu
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Yabing Duan
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Xin Yuan
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hengchao Wu
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hansong Sun
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
| | - Hongwen Ji
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Abstract
OBJECTIVE The aim of this study was to assess the efficacy and safety of intravenous ferric carboxymaltose (FCM) following hospitalization for acute gastrointestinal bleeding (AGIB) in the context of a restrictive transfusion strategy. PATIENTS AND METHODS A retrospective single-center study analyzed patients with AGIB (excluding AGIB secondary to portal hypertension) administered a single FCM dose with or without blood transfusion. RESULTS Eighty-six episodes in 84 patients were analyzed. Seventy-nine patients had upper AGIB. Nineteen episodes were associated with hemodynamic instability. FCM was administered during hospitalization as a single dose of 1000 mg iron in 84/86 episodes and as a single dose of 500 mg iron in two episodes, with blood transfusion in 60/86 (69.8%) episodes. The mean hemoglobin (Hb) was 9.0 g/dl at admission, 7.6 g/dl at the lowest in-hospital value, 9.4 g/dl at discharge, and 12.7 g/dl at follow-up (mean: 55 days postdischarge) (P<0.001 for follow-up vs. all other timepoints). The lowest mean in-hospital Hb value was 7.2 and 8.8 g/dl, respectively, in patients with transfusion+FCM versus FCM alone; the mean Hb was 12.4 versus 13.7 g/dl at follow-up. In patients administered FCM alone, the mean Hb at follow-up in the subpopulations aged older than or equal to 75 years (n=33), Charlson comorbidity index of at least 3 (n=48), and Hb of up to 10 g/dl at admission (n=47) were 12.6, 13.1, and 13.3 g/dl, respectively. No adverse effects were detected. CONCLUSION Treatment with FCM for AGIB is associated with a good erythropoietic response and anemia correction after hospitalization, even in severe episodes or when transfusion is needed. FCM is safe and well tolerated, and may support a restrictive transfusion policy.
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Mulder MB, van den Hoek HL, Birnie E, van Tilburg AJP, Westerman EM. Comparison of hypersensitivity reactions of intravenous iron: iron isomaltoside-1000 (Monofer ® ) versus ferric carboxy-maltose (Ferinject ® ). A single center, cohort study. Br J Clin Pharmacol 2018; 85:385-392. [PMID: 30393904 DOI: 10.1111/bcp.13805] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 10/06/2018] [Accepted: 10/24/2018] [Indexed: 12/16/2022] Open
Abstract
AIMS Intravenous iron supplementation is widely used to treat iron deficiency and iron deficiency anemia when oral iron administration is ineffective or poorly tolerated. Hypersensitivity reactions (HSRs) during infusions are rare, but can be life-threatening. This study aimed to compare the risk for HSRs with the intravenous administration of iron isomaltoside-1000 and ferric carboxymaltose for the treatment of iron deficiency and iron deficiency anemia. METHODS This was a single-centre cohort study. Nurses and physicians were instructed to fill out an HSR registration form with every administration of intravenous iron. HSRs were distinguished into serious and non-serious HSRs using the Ring and Messmer classification. RESULTS HSRs occurred in 18/836 (2.1%) ferric carboxymaltose and 43/496 (8.7%) iron isomaltoside-1000 administrations. The crude risk for HSRs was 75% lower after ferric carboxymaltose treatment (RR = 0.248, 95% CI: 0.145-0.426, P < 0.0001). The risk for grade II HSRs was 88% lower after ferric carboxymaltoside (RR = 0.123, 95% CI: 0.051-0.294). The likelihood of HSRs was 3.4 times higher after the administration of iron isomaltoside-1000 (95% CI: 1.910-6.093, P < 0.0001). Regardless of the type of intravenous iron, patients with comorbidities have a factor 3.6 higher risk (95% CI: 1.899-6.739, P < 0.0001). CONCLUSIONS Ferric carboxymaltose is associated with a 75% lower risk for HSRs compared with iron isomaltoside-1000 in our population. The presence of a comorbidity raises the likelihood of an HSR by a factor of three regardless of the type of intravenous iron infusion. Further research is needed to clarify the underlying mechanism in various patient groups.
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Affiliation(s)
- Midas B Mulder
- Department of Clinical Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Hester L van den Hoek
- Central Hospital Pharmacy, The Hague, The Netherlands.,Department of Clinical Pharmacy, Haaglanden Medical Center, The Hague, the Netherlands
| | - Erwin Birnie
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Obstetrics, Division Women and Baby, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Elsbeth M Westerman
- Department of Clinical Pharmacy, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Negi PC, Dev M, Paul P, Pal Singh D, Rathoure S, Kumar R, Dhiman A, Kandoria A, Ganju N, Sharma R, Bhardwaj R, Merwaha R, Asotra S, Mahajan K, Sondhi S, Rao S. Prevalence, risk factors, and significance of iron deficiency and anemia in nonischemic heart failure patients with reduced ejection fraction from a Himachal Pradesh heart failure registry. Indian Heart J 2018; 70 Suppl 3:S182-S188. [PMID: 30595254 PMCID: PMC6310070 DOI: 10.1016/j.ihj.2018.10.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The study aimed to estimate the prevalence, risk determinants, and its clinical significance of iron deficiency and anemia in patients of nonischemic heart failure with reduced ejection fraction (HFrEF). METHODS Serum ferritin, transferrin saturation, and the hemoglobin (Hb) levels were measured in 226 consecutive patients with HFrEF diagnosed based on the left ventricular ejection fraction ≤ 45% and absence of coronary artery luminal narrowing of more than 50%, in a prospective tertiary care hospital-based heart failure registry. Patients with the New York Heart Association functional class III/IV were classified as patients with advanced heart failure. Multivariable logistic regression modeling was performed to assess the risk determinants of iron deficiency and anemia and their clinical significance as the risk factors for advanced heart failure. Odds ratio with 95% confidence interval (CI) was reported as the estimates of the strength of association between exposure and outcome variables. RESULTS Iron deficiency and anemia were prevalent in 58.8% (52.2%-65.1%) and 35.8% (29.8%-42.3%) of patients, respectively. Female gender [OR 3.5 (95% CI 1.9-6.5)], history of bleeding [OR 11.7 (95% CI 1.4-101.2)], and vegetarian diet [OR 2.5 (95% CI 1.4-4.6)] were significantly associated with iron deficiency, while diabetes [OR 3.0 (95% CI 1.40-6.5)], estimated glomerular filtration rate [OR 0.98 (95% CI 0.97-0.99)], history of bleeding [OR 13.0 (95% CI 2.3-70.9)], and female gender [OR 2.9 (95% CI 1.5-5.7)] had significant association with anemia. The Hb level (OR 0.82 (95% CI 0.70-0.96) and transferrin saturation (OR 0.98 (95% CI 0.96-0.99)] had a significant inverse association with symptoms of advanced heart failure. CONCLUSION Iron deficiency and anemia are common comorbidities associated with HFrEF. Low Hb and transferrin saturation are significantly associated with advanced heart failure. The findings have important implications in the management of heart failure.
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Peyrin-Biroulet L, Lopez A, Cummings JRF, Dignass A, Detlie TE, Danese S. Review article: treating-to-target for inflammatory bowel disease-associated anaemia. Aliment Pharmacol Ther 2018; 48:610-617. [PMID: 30069896 DOI: 10.1111/apt.14922] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 04/16/2018] [Accepted: 07/04/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Iron deficiency has a high prevalence in inflammatory bowel disease (IBD) patients, with negative impact on quality of life and work capacity. AIM To propose an innovative approach based on early intervention, treating to target and tight monitoring in the management of iron deficiency in IBD patients. METHODS We conducted a literature review on PubMed and Medline using pre-defined keywords and terms to identify relevant studies on iron deficiency in IBD. RESULTS Many physicians are focused on treating anaemia; however, anaemia is one of the consequences of iron deficiency. Hence, our therapeutic goal for these patients should evolve towards prevention of anaemia by screening and treating iron deficiency. Early diagnosis of iron deficiency is based on a combination of ferritin concentration and transferrin saturation. We consider that normalisation of these biomarkers reflects iron stores replenishment and should be considered as a major therapeutic goal. Treating iron deficiency regardless of the presence of anaemia seems to improve quality of life in several chronic conditions and should be considered as an innovative approach in IBD although strong evidence is still lacking. Tight monitoring is required to allow early detection of iron deficiency recurrence and to consider prompt additional iron supplementation. CONCLUSION We propose to extrapolate a three-step strategy (early detection and intervention, treating-to-target and tight monitoring) to the management of iron deficiency in IBD patients. Universally applied, this proactive approach is expected to result in better outcomes in IBD patients.
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Affiliation(s)
- Laurent Peyrin-Biroulet
- Department of Gastroenterology and NGERE unit, University Hospital of Nancy and Inserm, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Anthony Lopez
- Department of Gastroenterology and NGERE unit, University Hospital of Nancy and Inserm, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - J R Fraser Cummings
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust and Faculty of Medicine, University of Southampton, Southampton, UK
| | - Axel Dignass
- Department of Medicine I, Agaplesion Markus Hospital and Crohn Colitis Clinical Research Center Rhein-Main, Frankfurt/Main, Germany
| | - Trond Espen Detlie
- Department of Gastroenterology, Akershus University Hospital HF and Institute of Clinical Medicine, University of Oslo, Norway
| | - Silvio Danese
- IBD Center and Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Milan, Italy
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Zhang H, Zhabyeyev P, Wang S, Oudit GY. Role of iron metabolism in heart failure: From iron deficiency to iron overload. Biochim Biophys Acta Mol Basis Dis 2018; 1865:1925-1937. [PMID: 31109456 DOI: 10.1016/j.bbadis.2018.08.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/25/2018] [Accepted: 08/22/2018] [Indexed: 12/11/2022]
Abstract
Iron metabolism is a balancing act, and biological systems have evolved exquisite regulatory mechanisms to maintain iron homeostasis. Iron metabolism disorders are widespread health problems on a global scale and range from iron deficiency to iron-overload. Both types of iron disorders are linked to heart failure. Iron play a fundamental role in mitochondrial function and various enzyme functions and iron deficiency has a particular negative impact on mitochondria function. Given the high-energy demand of the heart, iron deficiency has a particularly negative impact on heart function and exacerbates heart failure. Iron-overload can result from excessive gut absorption of iron or frequent use of blood transfusions and is typically seen in patients with congenital anemias, sickle cell anemia and beta-thalassemia major, or in patients with primary hemochromatosis. This review provides an overview of normal iron metabolism, mechanisms underlying development of iron disorders in relation to heart failure, including iron-overload cardiomyopathy, and clinical perspective on the treatment options for iron metabolism disorders.
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Affiliation(s)
- Hao Zhang
- Division of Cardiology, Department of Medicine, Canada; Mazankowski Alberta Heart Institute, Canada
| | - Pavel Zhabyeyev
- Division of Cardiology, Department of Medicine, Canada; Mazankowski Alberta Heart Institute, Canada
| | - Shaohua Wang
- Mazankowski Alberta Heart Institute, Canada; Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Canada; Mazankowski Alberta Heart Institute, Canada.
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Delpeuch A, Ruivard M, Abergel A, Aumaitre O, Boisgard S, Bagel S, Sautou V. Financial impact of intravenous iron treatments on the management of anaemia inpatients: a 1 year observational study. Int J Clin Pharm 2018. [DOI: 10.1007/s11096-018-0611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Roger SD, Gaillard CA, Bock AH, Carrera F, Eckardt KU, Van Wyck DB, Cronin M, Meier Y, Larroque S, Macdougall IC. Safety of intravenous ferric carboxymaltose versus oral iron in patients with nondialysis-dependent CKD: an analysis of the 1-year FIND-CKD trial. Nephrol Dial Transplant 2018; 32:1530-1539. [PMID: 28339831 PMCID: PMC5837517 DOI: 10.1093/ndt/gfw264] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 06/06/2016] [Indexed: 01/06/2023] Open
Abstract
Background. The evidence base regarding the safety of intravenous (IV) iron therapy in patients with chronic kidney disease (CKD) is incomplete and largely based on small studies of relatively short duration. Methods. FIND-CKD (ClinicalTrials.gov number NCT00994318) was a 1-year, open-label, multicenter, prospective study of patients with nondialysis-dependent CKD, anemia and iron deficiency randomized (1:1:2) to IV ferric carboxymaltose (FCM), targeting higher (400–600 µg/L) or lower (100–200 µg/L) ferritin, or oral iron. A post hoc analysis of adverse event rates per 100 patient-years was performed to assess the safety of FCM versus oral iron over an extended period. Results. The safety population included 616 patients. The incidence of one or more adverse events was 91.0, 100.0 and 105.0 per 100 patient-years in the high ferritin FCM, low ferritin FCM and oral iron groups, respectively. The incidence of adverse events with a suspected relation to study drug was 15.9, 17.8 and 36.7 per 100 patient-years in the three groups; for serious adverse events, the incidence was 28.2, 27.9 and 24.3 per 100 patient-years. The incidence of cardiac disorders and infections was similar between groups. At least one ferritin level ≥800 µg/L occurred in 26.6% of high ferritin FCM patients, with no associated increase in adverse events. No patient with ferritin ≥800 µg/L discontinued the study drug due to adverse events. Estimated glomerular filtration rate remained the stable in all groups. Conclusions. These results further support the conclusion that correction of iron deficiency anemia with IV FCM is safe in patients with nondialysis-dependent CKD.
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Affiliation(s)
| | - Carlo A Gaillard
- Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andreas H Bock
- Department of Nephrology, Kantonsspital, Aarau, Switzerland
| | | | - Kai-Uwe Eckardt
- Department of Nephrology and Hypertension, University of Erlangen-Nürnberg, Erlangen, Germany
| | - David B Van Wyck
- Clinical Support Services, Davita Healthcare Partners, Denver, CO, USA
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[Iron deficiency: Recent pathophysiological approach and treatment consequences]. Rev Med Interne 2018; 39:381-385. [PMID: 29610005 DOI: 10.1016/j.revmed.2018.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/05/2018] [Accepted: 03/03/2018] [Indexed: 12/17/2022]
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Lu Q, Peng H, Zhou G, Yin D. Perioperative Blood Management Strategies for Total Knee Arthroplasty. Orthop Surg 2018; 10:8-16. [PMID: 29424017 PMCID: PMC6594499 DOI: 10.1111/os.12361] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 11/24/2017] [Indexed: 01/28/2023] Open
Abstract
Total knee arthroplasty (TKA) often causes a significant amount of blood loss with an accompanying decline in hemoglobin and may increase the frequency of allogeneic blood transfusion rates. Unfortunately, allogeneic blood transfusions have associated risks including postoperative confusion, infection, cardiac arrhythmia, fluid overload, increased length of hospital stay, and increased mortality. Other than reducing the need for blood transfusions, reducing perioperative blood loss in TKA may also minimize intra-articular hemorrhage, limb swelling, and postoperative pain, and increase the range of motion during the early postoperative period. These benefits improve rehabilitation success and increase patients' postoperative satisfaction. Preoperative anemia, coupled with intraoperative and postoperative blood loss, is a major factor associated with higher rates of blood transfusion in TKA. Thus, treatment of preoperative anemia and prevention of perioperative blood loss are the primary strategies for perioperative blood management in TKA. This review, combined with current evidence, analyzes various methods of blood conservation, including preoperative, intraoperative, and postoperative methods, in terms of their effectiveness, safety, and cost. Because many factors can be controlled to reduce blood loss and transfusion rates in TKA, a highly efficient, safe, and cost-effective blood management strategy can be constructed to eliminate the need for transfusions associated with TKA.
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Affiliation(s)
- Qiang Lu
- Department of OrthopaedicsRenmin Hospital of Wuhan UniversityWuhanChina
| | - Hao Peng
- Department of OrthopaedicsRenmin Hospital of Wuhan UniversityWuhanChina
| | - Guan‐jin Zhou
- Department of Orthopaedics, Puai Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
| | - Dong Yin
- Department of OrthopaedicsThe People’s Hospital of Guangxi Zhuang Autonomous RegionNanningChina
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López-Aliaga I, García-Pedro JD, Moreno-Fernandez J, Alférez MJM, López-Frías M, Díaz-Castro J. Fermented goat milk consumption improves iron status and evokes inflammatory signalling during anemia recovery. Food Funct 2018; 9:3195-3201. [PMID: 29872815 DOI: 10.1039/c8fo00552d] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In spite of the crucial role of the inflammatory state under anemic conditions, to date, no studies have directly tested the modulation of cytokines during iron overload.
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Affiliation(s)
- Inmaculada López-Aliaga
- Department of Physiology
- University of Granada
- Granada
- Spain
- Institute of Nutrition and Food Technology “José Mataix Verdú”
| | | | - Jorge Moreno-Fernandez
- Department of Physiology
- University of Granada
- Granada
- Spain
- Institute of Nutrition and Food Technology “José Mataix Verdú”
| | - Mª José M. Alférez
- Department of Physiology
- University of Granada
- Granada
- Spain
- Institute of Nutrition and Food Technology “José Mataix Verdú”
| | - Magdalena López-Frías
- Department of Physiology
- University of Granada
- Granada
- Spain
- Institute of Nutrition and Food Technology “José Mataix Verdú”
| | - Javier Díaz-Castro
- Department of Physiology
- University of Granada
- Granada
- Spain
- Institute of Nutrition and Food Technology “José Mataix Verdú”
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Dalal J, Katekhaye V, Jain R. Effect of ferric carboxymaltose on hospitalization and mortality outcomes in chronic heart failure: A meta-analysis. Indian Heart J 2017; 69:736-741. [PMID: 29174251 PMCID: PMC5717300 DOI: 10.1016/j.ihj.2017.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/07/2017] [Accepted: 10/11/2017] [Indexed: 12/23/2022] Open
Abstract
Introduction Iron administration especially intravenous iron therapy is associated with improvements in exercise capacity and quality of life in patients with chronic heart failure (CHF). Our aim was to assess effect of ferric carboxymaltose (FCM) on hospitalization and mortality outcomes in CHF. Materials and methods A literature search across PUBMED, Google Scholar and trials database www.clinicaltrials.gov was conducted to search for randomized controlled trials (till August 2016) comparing FCM to placebo in CHF with or without anaemia. Published human studies in English language which reported data on mortality and hospitalization rates were included. Primary outcome was rates of HF hospitalizations and secondary outcomes were hospitalization due to any cardiovascular (CV) cause, death due to worsening HF and any CV death. Results From 17 studies identified, two were included in final analysis (n = 760; 455 in FCM and 305 in placebo arms). We observed significantly lower rates of hospitalization for worsening HF in FCM arm [Risk Ratio (RR) 0.34, 95% confidence interval (CI) 0.19, 0.59, p = 0.0001] as well as for any CV hospitalizations [RR 0.49, 95% CI 0.35, 0.70; p < 0.0001] (figure). No heterogeneity in studies was seen for these two outcomes (I2 = 0%, p > 0.05). No significant treatment effect with FCM was noted in mortality from worsening HF (RR 0.41, 95% CI 0.02, 7.36; p = 0.55) or any CV death (RR 0.80, 95% CI 0.40, 1.57; p = 0.51). Conclusion FCM reduces hospitalization rates in CHF but may not reduce mortality outcome. This finding needs further evaluation in a large, prospective, randomized controlled trial.
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Affiliation(s)
- Jamshed Dalal
- Centre for Cardiac Sciences, Kokilaben Dhirubhai Ambani Hospital, Rao Saheb Achutrao Patwardhan Marg, Four Bunglows, Andheri West, Mumbai, Maharashtra 400053, India.
| | - Vijay Katekhaye
- Dev Clinic, Opp. Bhosala Vedh School, Ayachit Mandir Road, Mahal, Nagpur, Maharashtra 440032, India.
| | - Rishi Jain
- Medical Services Dept., Emcure Pharmaceuticals Ltd., Survey No. 255/2, Phase-I, M.I.D.C., Hinjawadi, Pune, Maharshtra 411057, India.
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Milovanovic S, Scaldaferri F, Canarecci S, Kheiraoui F, Ciancarella G, de Waure C, Collamati A, Schiavoni E, Gasbarrini A, Boccia S, Poscia A. Therapy experiences and preferences among patients with anemia: Results of a cross-sectional survey among Italian patients with inflammatory bowel disease. Dig Liver Dis 2017; 49:1098-1103. [PMID: 28778820 DOI: 10.1016/j.dld.2017.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/16/2017] [Accepted: 06/28/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Anemia represents one of the most common and often the least treated complications of inflammatory bowel disease (IBD). AIMS Our study investigates experiences and preferences concerning anemia treatment in patients with IBD. METHODS IBD patients previously diagnosed with anemia were invited to participate in an anonymous survey between July and September 2015, which assessed demographic and clinical data, and experiences regarding anemia treatment. RESULTS A total of 118 IBD patients were invited to participate in the study, of which 100 (85%) were included in the analysis. Seventy-five percent of patients reported a high personal burden related to intravenous therapy, while the majority of companions (76%) declared a moderate burden. The increased importance assigned to the possibility of a single session treatment was significantly associated with age (Beta=0.01; p=0.03), working status (Beta=0.02; p=0.04), anemia severity (severe vs. mild, Beta=0.42; p=0.03), and intravenous treatment (Beta=0.44; p=0.001). CONCLUSIONS Most patients reported a high personal and a moderate companions' burden. Having the possibility of effective single dose intravenous therapy was of great importance. Patients' perspective provides key information for evaluating the indirect costs of anemia treatment in IBD which, according to the health technology assessment approach, could be useful in a patient centered decision making process.
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Affiliation(s)
- Sonja Milovanovic
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Franco Scaldaferri
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy.
| | | | - Flavia Kheiraoui
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Giulia Ciancarella
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Chiara de Waure
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Agnese Collamati
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
| | - Elisa Schiavoni
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Gastroenterology Unit, University Hospital "Agostino Gemelli", Largo F.Vito 1, 00168 Rome, Italy
| | - Stefania Boccia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy; Fondazione Policlinico "A. Gemelli", Largo F. Vito 1, 00168 Rome, Italy
| | - Andrea Poscia
- Institute of Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, Largo F.Vito 1, 00168 Rome, Italy
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Sustainability of Endovenous Iron Deficiency Anaemia Treatment: Hospital-Based Health Technology Assessment in IBD Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3470893. [PMID: 28761876 PMCID: PMC5518486 DOI: 10.1155/2017/3470893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 05/10/2017] [Accepted: 05/29/2017] [Indexed: 12/21/2022]
Abstract
Iron deficiency anaemia (IDA) is the main extraintestinal manifestation affecting patients with inflammatory bowel disease (IBD). The Health Technology Assessment approach was applied to evaluate the sustainability of intravenous (IV) iron formulations in the Italian hospital setting, with particular focus on ferric carboxymaltose. Data on the epidemiology of IBD and associated IDA, in addition to the efficacy and safety of IV iron formulations currently used in Italy, were retrieved from scientific literature. A hospital-based cost-analysis of the outpatient delivery of IV iron treatments was performed. Organizational and ethical implications were discussed. IDA prevalence in IBD patients varies markedly from 9 to 73%. IV iron preparations were proven to have good efficacy and safety profiles, and ferric carboxymaltose provided a fast correction of haemoglobin and serum ferritin levels in iron-deficient patients. Despite a higher price, ferric carboxymaltose would confer a beneficial effect to the hospital, in terms of reduced cost related to individual patient management and additionally to the patient by reducing the number of infusions and admissions to healthcare facilities. Ethically, the evaluation is appropriate due to its efficacy and compliance. This assessment supports the introduction of ferric carboxymaltose in the Italian outpatient setting.
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