EPO, Higher Transfusion Threshold No Benefit After TBI
(HealthDay News) — Neither erythropoietin nor a high hemoglobin transfusion threshold improve neurological recovery after traumatic brain injury, according to a study published in the July 2 issue of the Journal of the American Medical Association.
Claudia S. Robertson, MD, from the Baylor College of Medicine in Houston, and colleagues conducted a randomized clinical trial involving 200 patients with closed head injury. The authors sought to compare the effects of erythropoietin administration and two hemoglobin transfusion thresholds (7 and 10g/dL) on neurological recovery. The participants were randomized to receive erythropoietin (102 patients) or placebo (98 patients) daily for three days and then weekly for two more weeks (74 patients). The hemoglobin transfusion threshold was 7g/dL for 99 patients and 10g/dL for 101 patients.
The researchers found that both erythropoietin groups were futile compared with placebo (favorable outcome rate, 48.6 and 29.8%, respectively, for first and second dosing regimens, compared with 38.2% for placebo). For the 7 and 10g/dL hemoglobin transfusion thresholds, favorable outcome rates were 42.5 and 33.0% (P=0.28). The incidence of thromboembolic events was higher for the transfusion threshold of 10g/dL vs. 7g/dL (21.8 vs. 8.1%; odds ratio, 0.32; P=0.009).
"In patients with closed head injury, neither the administration of erythropoietin nor maintaining hemoglobin concentration of greater than 10g/dL resulted in improved neurological outcome at six months," the authors write.