Iron infusion before heart surgery helps patients recover faster
A simple iron infusion administered in the weeks before heart surgery could soon become standard care after a landmark international clinical trials study showed it reduces blood transfusions and shortens recovery.
The world-wide study published in the British Medical Journal involved 955 patients across 33 Australian hospitals and nine internationally and is the first large-scale trial to show that intravenous iron can improve outcomes for anaemic cardiac patients.
The Intravenous iron to treat anaemia before cardiac surgery (ITACS): an international, double blind, placebo controlled randomised trial was funded by the National Health and Medical Research Council and the Australian and New Zealand College of Anaesthetists.
The trial was led by The Alfred hospital and Monash University.
One third of patients requiring cardiac surgery are affected by anaemia, a condition that leaves them with fewer oxygen-carrying red blood cells and increases their risk of needing a blood transfusion during or after surgery, said Distinguished Professor Paul Myles, Director of Research in the Department of Anaesthesiology and Perioperative Medicine at The Alfred and Monash University.
“This study is set to change the way heart specialists prepare for surgery, with up to 40 per cent of patients currently requiring blood products during or after their procedure,” said Prof Myles.
“Blood transfusions are associated with a higher risk of complications and longer hospital stays, making it important to reduce their use wherever possible.”
Patients who received intravenous iron were one-third less likely to require a blood transfusion during their hospital stay compared with those who received a placebo, also spending more time at home recovering in the first three months after surgery.
For every 100 patients treated with intravenous iron, the study saved 44 units of blood products, reducing demand on blood supplies while improving patient outcomes.
“Not only did it lead to better outcomes for them, but it meant that we were able to improve outcomes for one of our most vulnerable groups – patients with anaemia,” said Prof Myles.
Iron deficiency is the most common cause of anaemia, although the condition is also common among people living with chronic illnesses including heart disease, kidney disease and diabetes, all of which are frequently seen in heart failure.
“Both anaemia and blood transfusions are associated with a higher risk of complications and longer stays in intensive care and hospital, and while iron tablets are often used to treat anaemia, they can work too slowly for patients awaiting surgery,” said Prof Myles.
“These results clearly show that a single infusion safely restored iron levels in the lead up to their procedure and left patients better off.”
