The effect of a preoperative erythropoietin protocol as part of a multifaceted blood management program in daily clinical practice (CME)

Authors

  • Hieronymus J. Doodeman,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Ingrid M.M. van Haelst,

    Corresponding author
    1. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    2. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
    • Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
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  • Toine C.G. Egberts,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Martin Bennis,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Han S. Traast,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Wouter W. van Solinge,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Cor J. Kalkman,

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Wilton A. van Klei

    1. Department of Clinical Pharmacy, Department of Anesthesiology, Medical Center Alkmaar, Alkmaar, the Netherlands
    2. Department of Clinical Pharmacy, Department of Clinical Chemistry and Haematology, Department of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center
    3. Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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  • Support was provided solely from institutional and/or departmental sources.

Address reprint requests to: Ingrid M.M. van Haelst, PharmD, Medical Centre Alkmaar, Hospital Pharmacy, Wilhelminalaan 12, 1815 JD Alkmaar, the Netherlands; e-mail: i.van.haelst@mca.nl.

Abstract

Background

The effectiveness of a preoperative erythropoietin (EPO) protocol to reduce allogeneic blood transfusions (ABTs) in daily clinical practice has been insufficiently studied. This study evaluated the effect of such a protocol, as part of a multifaceted blood management program, in patients undergoing total hip arthroplasty (THA).

Study Design and Methods

This retrospective observational study was designed as an interrupted time series (1999-2010). The intervention was the introduction of an EPO protocol in THA patients in 2003. Patients were classified according to preoperative hemoglobin (Hb) level: 10 to 13 g/dL (eligible patients for EPO) and more than 13 g/dL. The primary outcome was the percentage of patients receiving an ABT. Segmented regression analysis was used to estimate changes in outcome after the intervention.

Results

A total of 4568 THA patients were included. The absolute reductions in ABTs after the intervention were 17% (95% confidence interval [CI], 6%-29%) for the total study population and 25% (95% CI, 11%-39%) and 8% (95% CI, −5% to 21%) for the Hb groups 10 to 13 and more than 13 g/dL, respectively. In the postintervention period, 46% of the eligible patients (Hb level, 10-13 g/dL) actually received EPO. The transfusion rate in the EPO group was lower compared to the non-EPO group: 14 and 50%, respectively (p < 0.01).

Conclusion

Introduction of a preoperative EPO protocol reduced the transfusion rate in THA patients in daily clinical practice. The reduction must be seen as part of a multifaceted blood management program, in which increased awareness of blood transfusion contributes simultaneously and substantially to the reduction in transfusion rate.

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