Erythropoietin to reduce allogeneic red blood cell transfusion in patients undergoing total hip or knee arthroplasty.
The authors conducted a systematic review and meta-analysis to assess the benefits, the safety and the costs of recombinant human erythropoietin (rHuEPO) in total hip arthroplasty (THA) and total knee arthroplasty (TKA). Seven studies including a total of 2497 patients were selected for the meta-analysis.
Globally, rHuEPO reduced the exposure to allogeneic RBC transfusion by 54%. Erythropoietin treatment was equally effective in THA and TKA patients. Thromboembolic and vascular adverse events were not increased by the administration of rHuEPO.
Only one study reported the costs associated with rHuEPO. In that study, the use of rHuEPO increased costs by EUR 785 per patient or EUR 7300 per transfusion avoided. These findings are important in the context of patient blood management (PBM) since rHuEPO will represent a major expense in the management of preoperatively anaemic patients. It remains to be shown that the expense is worth the purported benefits of PBM, i.e. decreased morbidity, length of stay and mortality.
– Jean-François Hardy