Adverse events of iron and/ or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients : a systematic review

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dc.contributor.authorLaermans, Jorienen_ZA
dc.contributor.authorVan Remoortel, Hansen_ZA
dc.contributor.authorAvau, Berten_ZA
dc.contributor.authorBekkering, Geertruidaen_ZA
dc.contributor.authorGeorgsen, Jorgenen_ZA
dc.contributor.authorManzini, Paola Mariaen_ZA
dc.contributor.authorMeybohm, Patricken_ZA
dc.contributor.authorOzier, Yvesen_ZA
dc.contributor.authorDe Buck, Emmyen_ZA
dc.contributor.authorCompernolle, Veerleen_ZA
dc.contributor.authorVandekerckhove, Philippeen_ZA
dc.date.accessioned2024-02-01T07:45:00Z
dc.date.available2024-02-01T07:45:00Z
dc.date.issued2022-10-27en_ZA
dc.descriptionThe original publication is available at: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-022-02081-5en_ZA
dc.descriptionCITATION: Laermans, J. et al. 2022. Adverse events of iron and/or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients: a systematic review. Syst Rev 11(224):17 pages . doi.10.1186/s13643-022-02081-5en_ZA
dc.description.abstractBackground: Iron supplementation and erythropoiesis-stimulating agent (ESA) administration represent the hallmark therapies in preoperative anemia treatment, as reflected in a set of evidence-based treatment recommendations made during the 2018 International Consensus Conference on Patient Blood Management. However, little is known about the safety of these therapies. This systematic review investigated the occurrence of adverse events (AEs) during or after treatment with iron and/or ESAs. Methods: Five databases (The Cochrane Library, MEDLINE, Embase, Transfusion Evidence Library, Web of Science) and two trial registries (ClinicalTrials.gov, WHO ICTRP) were searched until 23 May 2022. Randomized controlled trials (RCTs), cohort, and case-control studies investigating any AE during or after iron and/or ESA administration in adult elective surgery patients with preoperative anemia were eligible for inclusion and judged using the Cochrane Risk of Bias tools. The GRADE approach was used to assess the overall certainty of evidence. Results: Data from 26 RCTs and 16 cohort studies involving a total of 6062 patients were extracted, on 6 treatment comparisons: (1) intravenous (IV) versus oral iron, (2) IV iron versus usual care/no iron, (3) IV ferric carboxymaltose versus IV iron sucrose, (4) ESA+iron versus control (placebo and/or iron, no treatment), (5) ESA+IV iron versus ESA+oral iron, and (6) ESA+IV iron versus ESA+IV iron (different ESA dosing regimens). Most AE data concerned mortality/survival (n=24 studies), thromboembolic (n=22), infectious (n=20), cardiovascular (n=19) and gastrointestinal (n=14) AEs. Very low certainty evidence was assigned to all but one outcome category. This uncertainty results from both the low quantity and quality of AE data due to the high risk of bias caused by limitations in the study design, data collection, and reporting. Conclusions: It remains unclear if ESA and/or iron therapy is associated with AEs in preoperatively anemic elective surgery patients. Future trial investigators should pay more attention to the systematic collection, measurement, documentation, and reporting of AE data.en_ZA
dc.description.urihttps://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-022-02081-5en_ZA
dc.description.versionPublisher’s versionen_ZA
dc.format.extent17 pagesen_ZA
dc.identifier.citationLaermans, J. et al. 2022. Adverse events of iron and/or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients: a systematic review. Syst Rev 11(224):17 pages . doi.10.1186/s13643-022-02081-5en_ZA
dc.identifier.doi10.1186/s13643-022-02081-5en_ZA
dc.identifier.issn2046-4053 (online)en_ZA
dc.identifier.orcid0000-0002-6695-6019en_ZA
dc.identifier.urihttps://scholar.sun.ac.za/handle/10019.1/129226
dc.language.isoen_ZAen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subject.lcshBlood -- Transfusionen_ZA
dc.subject.lcshPreoperative careen_ZA
dc.subject.lcshAnemia -- Treatmenten_ZA
dc.subject.lcshBlood -- Managementen_ZA
dc.titleAdverse events of iron and/ or erythropoiesis-stimulating agent therapy in preoperatively anemic elective surgery patients : a systematic reviewen_ZA
dc.typeArticleen_ZA
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