Randomized trial comparing ferric carboxymaltose vs oral ferrous glycine sulphate for postoperative anaemia after total knee arthroplasty.

Bisbe E, Moltó L, Arroyo R, Muniesa JM, Tejero M
Br J Anaesth 2014;113:402-409.
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Review by : M. Muñoz
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This randomised, controlled study evaluated the efficacy of intravenous ferric carboxymaltose (FCM; n = 60) vs. oral iron (n = 62) for the treatment of postoperative anaemia (Hb 8.5–12.0 g/dL) after total knee arthroplasty in patients that were not anaemic preoperatively.

FCM-treated patients showed a trend towards higher Hb increase from postoperative day 4 to postoperative day 30 and better scores for ‘usual activities’. No intravenous iron-related adverse events were reported. In addition, patients with postoperative Hb <10 g/dL, low preoperative iron stores (ferritin <100 ng/mL), or both, experienced better Hb increase with FCM than with oral iron. However, while these results were in agreement with previous observations and recommendations regarding very short-term perioperative iron therapy [1,2], this subgroup analysis lacked statistical power. Regarding costs, in a recent observational study of patients presenting with or without preoperative anaemia, postoperative intravenous iron after total lower limb arthroplasty appeared to be safe and was associated with reduced transfusion rates, without incremental costs [3]. However, for anaemic patients, the efficacy of intravenous iron could have been improved by associating single doses recombinant human erythropoietin (40,000 IU), as reported in patients undergoing hip fracture repair surgery [4]. Therefore, these promising results emphasise the importance of perioperative iron status and Hb assessments and justify conducting a larger randomised controlled trial on the efficacy of postoperative intravenous iron (with or without recombinant human erythropoietin) in this patient population. – Manuel Muñoz


1. Beris P, Muñoz M, Garcia-Erce JA, et al. Br J Anaesth 2008;100:599-604.
2. Muñoz M, Gómez-Ramirez S, Cuenca J, et al. Transfusion 2014;54:289-299.
3. Muñoz M, Gómez-Ramírez S, Martín-Montañez E, et al. Blood Transfus 2014;12:40-9.
4. Muñoz M, Iglesias D, Garcia-Erce JA, et al. Vox Sang 2014;106:83-91.

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