Effect of Preoperative Recombinant Human Erythropoietin on the Need for Blood Transfusion and Surgical Outcomes in Adult Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis with Trial Sequential Analysis

Abstract

This study aimed to examine the value of preoperative recombinant human erythropoietin (rhEPO) administration to adults undergoing elective cardiac surgery. Databases were searched for randomized controlled trials (RCTs) comparing rhEPO plus standard treatment versus standard treatment only. Primary outcomes were the need for and volume of homologous blood transfusion (HBT). Secondary outcomes were the length of intensive care unit (ICU) and hospital stay and the incidence of major adverse events. There was very low certainty that rhEPO is associated with a reduction in the need for HBT with a number needed to treat (95% CI) of 5.6 (3.9, 12.5), and low certainty that it is associated with a moderate reduction in HBT volume (Hegdes's g = -0.55, 95% CI = -0.79 to -0.32). Meta-regression revealed that studies with a higher proportion of females or older patients demonstrated less benefit of rhEPO as regards the reduction in the consumption of HBT. Trial sequential analysis showed rhEPO was superior to standard treatment only for reducing the need for and volume of HBT. With regards to secondary outcomes, there was moderate certainty that rhEPO is associated with a limited reduction in the length of ICU (Hegdes's g = -0.10, 95% CI = -0.19 to -0.01) and hospital stay (Hegdes's g = -0.13, 95% CI = -0.25 to -0.02), and low certainty for increased risk of myocardial infarction with number needed to harm (95% CI) of 36.1 (17.9, 127.4). Further well-designed, adequately-powered RCTs are needed to make conclusions regarding the value of rhEPO.