Efficacy and Safety of Erythropoietin and Intravenous Iron in Perioperative Blood Management: A Systematic Review
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Protocol Registration and Eligibility Criteria
We carefully adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines throughout the entire process of writing this systematic review and registered a protocol online in advance (PROSPERO 2012:CRD42012002599). The PICOS approach was used to define the criteria for inclusion (Table 1). Any disagreements between review authors (DL and MT) in the process of study selection and appraisal were resolved by discussion.
Search Strategy and Information Sources
We conducted a systematic literature search of
Study Selection and Characteristics
The study selection process is depicted in Fig. Most identified records were easily excluded by the title or abstract alone. After this initial screening, records that potentially fulfilled the inclusion criteria were selected for full-text review. Thirty-nine articles were eligible for inclusion, of which 8 studies were identified through manual search of references. In the end, 24 RCTs and 15 nonrandomized studies with a comparator group were included in the final review. In Table 3A, Table 3B
Discussion
The strength of this systematic review lies in our careful adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, including a rigorous appraisal process using the Cochrane risk of bias tool. This systematic review is limited by a search strategy restricted to English publications and exclusion criteria for autologous blood donation, children, and pregnant women. Most included studies were assessed to be at least at moderate risk of bias; therefore, the following
Conclusion
In recent years, an effort to reduce perioperative RBC transfusions has led to a growing number of trials studying EPO and IV iron as a bloodless therapeutic modality [3]. Perioperative blood management strategies might benefit from targeting the underlying pathophysiology of functional iron deficiency by choosing pharmacological therapies that would enhance the marrow's erythropoietic drive, particularly in cases of preoperative iron deficiency anemia. Taken together, the 8 low risk of bias
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Conflict of interest statement: This study was performed without external funding.