Preoperative IV iron to anemic patients may not reduce blood transfusion need, death: Lancet

London, UK: The administration of preoperative intravenous iron to anemic patients 10–42 days before elective major abdominal surgery was not effective than a placebo for reducing the need for blood transfusion, according to findings from the PREVENTT trial. The study is published in the journal Lancet.

About 30-60% of the patients undergoing major elective surgery are affected by preoperative anemia. It is associated with an increased risk of blood transfusion, in-hospital complications, poor recovery, and delayed hospital discharge. Toby Richards, Fiona Stanley Hospital, Perth, WA, Australia, and colleagues aimed to test the hypothesis whether the administration of intravenous iron to anemic patients before major open elective abdominal surgery would help in correcting anemia, improving patient outcomes, and reducing the need for blood transfusions.

The researchers recruited adult participants halving anemia at preoperative hospital visits before elective major open abdominal surgery at 46 UK tertiary care centers. Anemia was defined as hemoglobin of less 120 g/L for women and 130 g/L for men. 

487 were randomly assigned in the ratio 1:1 to receive intravenous iron (n=244) or placebo (n=243) 10–42 days before surgery. complete data for the primary endpoints were available for 474 (97%) individuals. Intravenous iron was administered as a single 1000 mg dose of ferric carboxymaltose in 100 mL normal saline, and the placebo was 100 mL normal saline, both given as an infusion over 15 min.