We are performing the above prospective randomized trial in 1'000 patients undergoing cardiac surgery. The study will answer the question of whether preoperative treatment of anemia or iron deficiency indeed improves transfusion needs (primary outcome) and important clinical outcomes (secondary outcome) in a large group of cardiac surgical patients. The list of inclusion and exclusion criteria was deliberately chosen short so that this patient group largely reflects today's clinical practice . * Trial with medical product
Anemic or iron deficiency patients are randomized into treatment and placebo groups. Treatment (see below) will be given the day before the operation (day -1) or a maximum of 2 days prior to the operation (day -2) in iron deficiency patients and a maximum of 3 days prior to the operation in anemic patients (day -3). The treatment will not be disclosed to the patient or the health care workers treating the patients during and after the operation. Patients without anemia or iron deficiency will also be observed and the same postoperative measurements performed. They will serve as a natural comparison group. Treatment: Erythropoietin alpha (Eprex, Janssen-Cilag AG, Baar) 40'000 U sc. Ferric carboxymaltose (Ferinject, Vifor (International) AG, St. Gallen) 1000 mg in 100 ml sodiumchloride (NaCl) over 30 min. Vitamin B12 (Vitarubin®-superconc., Streuli Pharma AG, Uznach) 1 mg sc. Folic acid (Acidum folicum, Streuli Pharma AG, Uznach) 5 mg po. The current transfusion and coagulation guidelines of the University Hospital of Zurich are followed in both groups identically. Postoperatively on the regular ward a Hb transfusion trigger of 80 g/L is applied
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
1,003
Treatment ) will be given the day before the operation (day -1) or a maximum of 2 days prior to the operation (day -2) in iron deficiency patients and a maximum of 3 days prior to the operation in anemic patients (day -3). Erythropoietin alpha (Eprex, Janssen-Cilag AG, Baar) 40'000 U sc. Ferric carboxymaltose (Ferinject, Vifor (International) AG, St. Gallen) 1000 mg in 100 ml NaCl over 30 min. Vitamin B12 (Vitarubin®-superconc., Streuli Pharma AG, Uznach) 1 mg sc. Folic acid (Acidum folicum, Streuli Pharma AG, Uznach) 5 mg po.
University Hospital Zurich, Institute of Anaesthesiology
Zurich, Canton of Zurich, Switzerland
Red blood cell (RBC) units transfused
Time frame: 7 days
Percentage of patients without any RBC transfusions
Time frame: 90 days
Combined allogeneic transfusions (RBC, FFP( fresh frozen plasma), platelets)
Time frame: 90 days
Length of stay in the intensive care unit (ICU)
Time frame: 90 days
Duration of mechanical ventilation
Time frame: 90 days
Acute kidney failure
RIFLE I, AKIN 2
Time frame: 7 days
Major Adverse Cardiac and Cerebrovascular Events (MACCE)
Myocardial infarction, stroke, death
Time frame: 90 days
New atrial fibrillation
Time frame: 90 days
Infections
Pneumonia, hospital acquired Deep Sternal Wound Infection Definition of infection: rise in inflammation markers after the initial postoperative period (acute phase reaction) and requires treatment and/ or prolongs days in hospital and/or microbiological confirmation of infection
Time frame: 7 days
Thrombotic and thromboembolic complications (90 days)
clinical symptoms and evidence of thrombosis/ embolism in one of the following imaging methods (ultrasound, CT-scan)
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Time frame: 90 days
Length of stay (LOS) in the hospital
Time frame: 90 days
Length of hospital stay (in comparison to median LOS published for relevant Swiss-DRGs)
Time frame: 90 days
In hospital mortality
Time frame: 90 days
30 day and 90-day mortality
Time frame: 90 days
Costs (for blood products and pharmaceutical products related to transfusion and anemia management)
Comparison of costs for study medication versus costs for blood products and products related to transfusion
Time frame: 90 days
Perioperative Hb concentrations
Time frame: 90 days
Calculated RBC and blood loss
Time frame: 90 days
Comparison of the treatment and placebo groups with the natural comparison group
Time frame: 90 days
Safety and tolerance of administered study drug and placebo
Comparison of all serious adverse events between study drug group and placebo group
Time frame: 90 days