Wednesday, September 12, 2007

Erythropoietin treatment in critical illness

Transfusion of red cells has been associated with adverse outcomes. The search for a safer alternative to red cell transfusion in critically ill patients has led to great interest in the use of erythropoietin to help patients maintain appropriate hemoglobin concentrations. A study in NEJM demonstrates again that evidence often tempers enthusiasm for appealing ideas. The EPO Critical Care Trials Group reported, in the September 6 issue, on the use of erythropoietin in critically ill patients. In the treatment group there was no reduction in the use of red cell transfusions and no significant improvement in mortality except in a subset of trauma patients. An increase in the rate of thromboembolism was seen in the erythropoietin group.

Deborah Cook and Mark Crowther in an accompanying editorial warned against premature conclusion that erythropoietin is beneficial in critically ill trauma patients. The absolute benefit was small and the relatively high incidence of VTE in trauma patients may result in a smaller number needed to harm than was reported for the overall group. They concluded:

Without a clear indication for initiating erythropoietin in all critically ill patients, new prescriptions for this drug should be restricted to randomized trials with independent research oversight carefully examining fatal and nonfatal clinically important outcomes.

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