The use of intravenous (IV) or oral iron with or without an erythropoiesis-stimulating agent (ESA) may help prevent post-operative anemia and reduce blood transfusions without significantly raising the risk of adverse events, study authors reported in a study published in Annals of Pharmacotherapy

Taylor D. Steuber, PharmD, BCPS, from Butler University College of Pharmacy and Health Sciences, Indianapolis, IN, and colleagues aimed to study the use of IV iron, oral iron, and ESAs for the prevention and management of post-operative anemia in patients undergoing elective orthopedic surgery, and to establish a clinical algorithm for use.

They conducted a search of PubMed and MEDLINE from 1964 through March 2016 for English-language prospective and retrospective human studies and meta-analyses evaluating oral or IV iron, ESA alone, or in combination, in surgery patients with reported blood transfusion outcomes. Nine prospective and retrospective studies as well as 1 meta-analysis were included for the review. 

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Dr. Steuber and his team found that pre-op administration of oral iron, IV iron, ESA alone or in combination resulted in significantly reduced transfusion rates. Rates of transfusion were generally less with combination therapy of ESA with oral or IV iron. 

The short-term peri-op or post-op administration of oral or IV iron, however, showed opposing results where some studies demonstrated a statistically significant reduction in blood transfusions and others demonstrated none. 

Overal, the study authors concluded that IV or oral iron with or without an ESA “may provide benefit” in the prevention of ost-operative anemia. These drugs may be an option at the lowest effective dose when given before the planned procedure. 

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