Deaths among critically ill cut by epoetin alfa
Treatment with epoetin alfa reduces mortality in critically ill patients, a new study has shown.
Epoetin alfa (40,000 units) or placebo was administered to 1,460 anaemic
patients in the intensive care units of 115 medical centres in the US.
After 29 days patients in the epoetin group had a greater increase in
haemoglobin concentration than those in the placebo group (P<0.001)
and mortality tended to be lower. A similar reduction in mortality was
seen at day 140, particularly in trauma patients (adjusted hazard ratio
0.86, 95 per cent confidence interval 0.65 to 1.13).
However, epoetin alfa was associated with increased thrombotic vascular
events (hazard ratio 1.41, 95 per cent confidence interval 1.06 to 1.86,
P=0.008). Post hoc analyses showed that the incidence of these events
was higher in those who had not received heparin at baseline, so the
researchers suggest that prophylactic heparin could be considered in
these patients.
An unexpected finding was that epoetin alfa did not reduce the need for
red-cell transfusions, which is at odds with previous studies. The researchers
also found that early administration may alter the risk-benefit ratio,
so epoetin alfa should not be administered before the patient has been
in intensive care for 48 hours.
They suggest that epoetin alfa has actions distinct from haematopoiesis
and conclude that it could benefit trauma patients who are in an intensive
care unit for more than 48 hours and have no history of thrombotic disease
(New England Journal of Medicine 2007;357:965).
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