Abstract 13109: Oral and Intravenous Iron Therapy for Iron Deficiency Anemia After Cardiac Surgery

Abstract

Introduction: cardiac surgery is associated with a high risk to develop iron deficiency anemia (IDA) with impact on the Cardiac Rehabilitation (CR) program. Sucrosomial Iron (SI) is a new oral iron with good gastrointestinal compliance and bioavailability Hypothesis: to compare SI with Ferric Carboxymaltose (FCM) i.v. the gold standard treatment for IDA. Methods: 67 consecutive patients admitted to a CR unit after cardiac surgery (27 CABG, 29 valves/aortic surgery, 11 CABG+valves) were alternately treated with SI or FCM. Blood parameters were assessed at the admission (8-10 days after surgery) (T1), at discharge (18-22 days after surgery) (T2) and 10 days from discharge (T3). The study design provides for a single dose of 1000 mg of FCM at T1 or a dose of 120 mg of SI per day for the first 8-10 days after T1; then SI was scaled to 30 mg/die up to T3. Two groups were comparable in terms of age (SI vs FCM: 67.3 ± 12.8 vs 70.2 ± 12.2) and ejection fraction (SI vs FCM: 52.7% ± 7.8 vs 53.9% ± 5.4). Because the small sample size, non-normal distributed longitudinal variables were logarithmically transformed, to guarantee the maximum possible power to the analysis. Results: data are shown in the following table. At T1, two treatment groups showed no statistically significant difference. Hemoglobin significantly increased in both groups, without significant difference at T3. Transferrin saturation and Sideremia significantly increase in both groups, although the correction is faster with FCM. Ferritin, elevated to baseline for inflammatory condition after surgery, is reduced in the SI group, while it increases significantly in FCM group. Conclusions: SI is able to correct post-surgical IDA in times and ways comparable to i.v. FCM. The hyperferritinemia observed with FCM at T2 may be due to a low-grade pro-inflammatory effect correlated to the high level of iron deposition in macrophages. SI is able to recover IDA and to achieve normal Ferritin values, avoiding the risk of hyperferritinemia.