Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS13. Preoperative Very Short Term High Dose Erythropoietin AdministrationDiminishes Blood Transfusion Rate in Off Pump Coronary ArteryBypass – A Randomized Blind Controlled StudyLuca Weltert, Stefano D’Alessandro, Saverio Nardella, Fabiana Girola,Alessandro Bellisario, Daniele Maselli, Ruggero De PaulisEuropean Hospital, Rome, ItalyInvited Discussant: Colleen KochOBJECTIVE: Human Recombinant Erythropoietin (HRE) has been used eitheras a single or refracted dose, to obtain rapid increase in red blood cells count a fewdays before surgery. The shortest preparatory administration interval up to nowwas 4 days. In everyday routine at our Institution only 2,4 days separate averagehospitalization and surgery. We therefore propose a randomized blind trial to testthe efficacy of high dose HRE in very short term administration.METHODS: All patients presenting with diagnosis of isolated coronary vesselsdisease were randomized to either HRE administration or control group. Patientswith Creatinin >2 mg/dl, Hb >14.5 g/dl or Hematocrit >44% were excluded.Administration doses were:Day –2, 14.000UI; Day –1, 14.000UI; Day 0 (Day of surgery), 8.000UI; Day 1,8.000UI; Day 2, 8.000UI (average 600UI/Kg/Week). Haemoglobin (Hb) valueswere collected preoperatively, and on postoperative day 1 and day 4. Blood loss andblood transfusion rate were recorded at time of discharge.RESULTS: Three-hundred-twenty consecutive patients were enrolled. All patientsunderwent OFF-pump coronary revascularization. No significant difference werepresent in Age, Ejection Fraction, Euroscore value, incidence of COPD, peripheralvasculopathy, instable angina, recent myocardial infarction, postoperative blood loss.Mean preoperative Hb value were similar between the two groups (p > 0,3). Threepatients required conversion to On-Pump revascularization and were excludedfrom the study. At Day 4 mean Hb was 15,5% higher in the HRE group (10.70 ± 0.72vs 9.26 ± 0.71 g/dl; p < 0,05). The HRE group required 0,33 blood units/per patientswhile the control group required 0,76 blood units/per patient (p = 0,008).CONCLUSION: A significant reduction in transfusion rate and a significantincrease in Hb values in HRE group were observed. No adverse events (thrombosis,allergic reactions) related to HRE administration were recorded. A very shortpreoperative HRE administration seem a safe, easy, and convenient method inreducing the need for blood transfusions.92