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Published in: Trials 1/2015

Open Access 01-12-2015 | Study protocol

PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial

Authors: Toby Richards, Ben Clevenger, Jane Keidan, Tim Collier, Andrew A. Klein, Stefan D. Anker, John D. Kelly

Published in: Trials | Issue 1/2015

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Abstract

Background

Anaemia is common in patients undergoing major surgery. The current standard of care for patients with low haemoglobin in the peri-operative period is blood transfusion. The presence of preoperative anaemia is associated with an increased likelihood of the patient receiving peri-operative transfusion and worsened outcomes following surgery, more post-operative complications, delayed recovery and greater length of hospital stay. Intravenous iron, if applied in the preoperative setting, may correct anaemia by the time of surgery and reduce the need for blood transfusion and improve outcomes.

Methods/Design

PREVENTT is a phase III double-blind randomised controlled trial that will compare the use of intravenous ferric carboxymaltose (dose 1000 mg) with placebo 10–42 days before major open abdominal surgery in 500 patients with anaemia (haemoglobin < 120 g/L). The primary outcome measure will be the need for blood transfusion and secondary endpoints will include post-operative recovery, length of hospital stay, health care utilisation and cost analysis.

Trial registration

ISRCTN67322816 – registered 9 October 2012.
ClinicalTrials.gov identifier: NCT01692418.
Literature
1.
go back to reference World Health Organization. Nutritional Anaemias: report of a WHO Scientific Group (meeting held in Geneva from 13 to 17 March 1967). Geneva: World Health Organization; 1968. World Health Organization. Nutritional Anaemias: report of a WHO Scientific Group (meeting held in Geneva from 13 to 17 March 1967). Geneva: World Health Organization; 1968.
2.
go back to reference Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010;113:482–95.CrossRefPubMed Spahn DR. Anemia and patient blood management in hip and knee surgery: a systematic review of the literature. Anesthesiology. 2010;113:482–95.CrossRefPubMed
3.
go back to reference Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med. 2004;116:58–69.CrossRef Shander A, Knight K, Thurer R, Adamson J, Spence R. Prevalence and outcomes of anemia in surgery: a systematic review of the literature. Am J Med. 2004;116:58–69.CrossRef
4.
go back to reference Musallam KM, Tamim HA, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396–407.CrossRefPubMed Musallam KM, Tamim HA, Richards T, Spahn DR, Rosendaal FR, Habbal A, et al. Preoperative anaemia and postoperative outcomes in non-cardiac surgery: a retrospective cohort study. Lancet. 2011;378:1396–407.CrossRefPubMed
5.
go back to reference Hung M, Ortmann E, Besser M, Martin-Cabrera P, Richards T, Ghosh M, et al. A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients. Heart. 2015;101:2. 107-112. Hung M, Ortmann E, Besser M, Martin-Cabrera P, Richards T, Ghosh M, et al. A prospective observational cohort study to identify the causes of anaemia and association with outcome in cardiac surgical patients. Heart. 2015;101:2. 107-112.
7.
go back to reference Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, et al. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest. 2004;113:1271–6.CrossRefPubMedPubMedCentral Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, et al. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J Clin Invest. 2004;113:1271–6.CrossRefPubMedPubMedCentral
8.
go back to reference Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion. 2007;47:1468–80.CrossRefPubMed Gombotz H, Rehak PH, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark study. Transfusion. 2007;47:1468–80.CrossRefPubMed
9.
go back to reference Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality and resource utilization in surgery. J Surg Res. 2002;102:237–44.CrossRefPubMed Dunne JR, Malone D, Tracy JK, Gannon C, Napolitano LM. Perioperative anemia: an independent risk factor for infection, mortality and resource utilization in surgery. J Surg Res. 2002;102:237–44.CrossRefPubMed
10.
go back to reference Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg. 2011;212:187–94.CrossRefPubMed Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg. 2011;212:187–94.CrossRefPubMed
11.
go back to reference National Clinical Guideline Centre (UK). Anaemia Management in Chronic Kidney Disease: Rapid Update 2011. London: Royal College of Physicians (UK); 2011. National Clinical Guideline Centre (UK). Anaemia Management in Chronic Kidney Disease: Rapid Update 2011. London: Royal College of Physicians (UK); 2011.
12.
go back to reference Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545–53.CrossRefPubMed Gasche C, Berstad A, Befrits R, Beglinger C, Dignass A, Erichsen K, et al. Guidelines on the diagnosis and management of iron deficiency and anemia in inflammatory bowel diseases. Inflamm Bowel Dis. 2007;13:1545–53.CrossRefPubMed
13.
go back to reference Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436–48.CrossRefPubMed Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436–48.CrossRefPubMed
14.
go back to reference Theusinger OM, Leyvraz P-F, Schanz U, Seifert B, Spahn DR. Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology. 2007;107:923–7.CrossRefPubMed Theusinger OM, Leyvraz P-F, Schanz U, Seifert B, Spahn DR. Treatment of iron deficiency anemia in orthopedic surgery with intravenous iron: efficacy and limits: a prospective study. Anesthesiology. 2007;107:923–7.CrossRefPubMed
15.
go back to reference Kochhar PK, Kaundal A, Ghosh P. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. J Obstet Gynaecol Res. 2012;39:504–10.CrossRefPubMed Kochhar PK, Kaundal A, Ghosh P. Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: a randomized clinical trial. J Obstet Gynaecol Res. 2012;39:504–10.CrossRefPubMed
16.
go back to reference Cuenca J, García-Erce JA, Muñoz M, Izuel M, Martínez AA, Herrera A. Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study. Transfusion. 2004;44:1447–52.CrossRefPubMed Cuenca J, García-Erce JA, Muñoz M, Izuel M, Martínez AA, Herrera A. Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study. Transfusion. 2004;44:1447–52.CrossRefPubMed
17.
go back to reference Serrano-Trenas JA, Ugalde PF, Cabello LM, Chofles LC, Lázaro PS, Benítez PC. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion. 2011;51:97–104.CrossRefPubMed Serrano-Trenas JA, Ugalde PF, Cabello LM, Chofles LC, Lázaro PS, Benítez PC. Role of perioperative intravenous iron therapy in elderly hip fracture patients: a single-center randomized controlled trial. Transfusion. 2011;51:97–104.CrossRefPubMed
18.
go back to reference Kim YH, Chung HH, Kang S-B, Kim SC, Kim YT. Safety and usefulness of intravenous iron sucrose in the management of preoperative anemia in patients with menorrhagia: a phase IV, open-label, prospective, randomized study. Acta Haematol. 2009;121:37–41.CrossRefPubMed Kim YH, Chung HH, Kang S-B, Kim SC, Kim YT. Safety and usefulness of intravenous iron sucrose in the management of preoperative anemia in patients with menorrhagia: a phase IV, open-label, prospective, randomized study. Acta Haematol. 2009;121:37–41.CrossRefPubMed
19.
go back to reference Díez-Lobo AI, Fisac-Martín MP, Bermejo-Aycar I, Muñoz M. Preoperative intravenous iron administration corrects anemia and reduces transfusion requirement in women undergoing abdominal hysterectomy. Transfus Altern Transfus Med. 2007;9:114–9.CrossRef Díez-Lobo AI, Fisac-Martín MP, Bermejo-Aycar I, Muñoz M. Preoperative intravenous iron administration corrects anemia and reduces transfusion requirement in women undergoing abdominal hysterectomy. Transfus Altern Transfus Med. 2007;9:114–9.CrossRef
20.
go back to reference Garcia-Erce JA, Cuenca J, Munoz M, Izuel M, Martinez AA, Herrera A, et al. Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study. Vox Sang. 2005;88:235–43.CrossRefPubMed Garcia-Erce JA, Cuenca J, Munoz M, Izuel M, Martinez AA, Herrera A, et al. Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study. Vox Sang. 2005;88:235–43.CrossRefPubMed
21.
go back to reference Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion. 2008;48:988–1000.PubMed Auerbach M, Goodnough LT, Picard D, Maniatis A. The role of intravenous iron in anemia management and transfusion avoidance. Transfusion. 2008;48:988–1000.PubMed
22.
go back to reference Beris P, Munoz M, Garcia-Erce JA, Thomas D, Maniatis A, Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br J Anaesth. 2008;100:599–604.CrossRefPubMed Beris P, Munoz M, Garcia-Erce JA, Thomas D, Maniatis A, Van der Linden P. Perioperative anaemia management: consensus statement on the role of intravenous iron. Br J Anaesth. 2008;100:599–604.CrossRefPubMed
23.
go back to reference Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677.PubMed Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, et al. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2009;3:CD003677.PubMed
24.
go back to reference Medeiros LRF, Rosa DD, Bozzetti MC, Fachel JMG, Furness S, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009;2:CD004751.PubMed Medeiros LRF, Rosa DD, Bozzetti MC, Fachel JMG, Furness S, Garry R, et al. Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev. 2009;2:CD004751.PubMed
25.
go back to reference Ahmed Ali U, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. 2009;1. Ahmed Ali U, Keus F, Heikens JT, Bemelman WA, Berdah SV, Gooszen HG, et al. Open versus laparoscopic (assisted) ileo pouch anal anastomosis for ulcerative colitis and familial adenomatous polyposis. Cochrane Database Syst Rev. 2009;1.
26.
go back to reference Grocott MPW, Browne JP, Van der Meulen J, Matejowsky C, Mutch M, Hamilton MA, et al. The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol. 2007;60:919–28.CrossRefPubMed Grocott MPW, Browne JP, Van der Meulen J, Matejowsky C, Mutch M, Hamilton MA, et al. The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. J Clin Epidemiol. 2007;60:919–28.CrossRefPubMed
27.
go back to reference Department of Health (UK). Delivering Enhanced Recovery - Helping Patients to get Better Sooner after Surgery: Best Practice Guidance 2010. London: Department of Health (UK); 2010. Department of Health (UK). Delivering Enhanced Recovery - Helping Patients to get Better Sooner after Surgery: Best Practice Guidance 2010. London: Department of Health (UK); 2010.
28.
go back to reference Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail. 2009;11:1084–91.CrossRefPubMedPubMedCentral Anker SD, Colet JC, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Rationale and design of Ferinject® Assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail. 2009;11:1084–91.CrossRefPubMedPubMedCentral
29.
go back to reference Ponikowski P, van Veldhuisen DJ, Comin Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J. 2015;36:657–68.CrossRefPubMed Ponikowski P, van Veldhuisen DJ, Comin Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J. 2015;36:657–68.CrossRefPubMed
30.
go back to reference Hofmann A, Farmer S, Shander A. Five drivers shifting the paradigm from product-focused transfusion practice to patient blood management. Oncologist. 2011;16:3–11.CrossRefPubMed Hofmann A, Farmer S, Shander A. Five drivers shifting the paradigm from product-focused transfusion practice to patient blood management. Oncologist. 2011;16:3–11.CrossRefPubMed
31.
go back to reference Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453–62.CrossRefPubMedPubMedCentral Carson JL, Terrin ML, Noveck H, Sanders DW, Chaitman BR, Rhoads GG, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011;365:2453–62.CrossRefPubMedPubMedCentral
32.
go back to reference Carson JL, Carless PA, Hébert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012;4:CD002042.PubMedPubMedCentral Carson JL, Carless PA, Hébert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012;4:CD002042.PubMedPubMedCentral
Metadata
Title
PREVENTT: preoperative intravenous iron to treat anaemia in major surgery: study protocol for a randomised controlled trial
Authors
Toby Richards
Ben Clevenger
Jane Keidan
Tim Collier
Andrew A. Klein
Stefan D. Anker
John D. Kelly
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Trials / Issue 1/2015
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-015-0774-2

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