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Intravenous Iron Preparations for Patients Undergoing Elective Surgery: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: March 27, 2019
Project Number: RC1088-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of intravenous iron preparations for patients identified as iron deficient undergoing elective cardiac surgery or other elective surgery?
  2. What is the cost-effectiveness of intravenous iron preparations for patients identified as iron deficient undergoing elective cardiac surgery or other elective surgery?
  3. What are the evidence-based guidelines regarding the use of intravenous iron preparations for patients identified as iron deficient undergoing elective cardiac surgery or other elective surgery?

Key Message

Limited quality evidence suggests that for adult anemic patients, intravenous iron administration resulted in better control of hemoglobin levels and fewer blood transfusions compared with no intravenous iron or usual care, however the between group differences were not always statistically significant. One study of limited quality suggested that infections were statistically significantly fewer with intravenous iron compared with no intravenous iron and that in terms of survival there was no statistically significant difference between the groups. One economic study showed that with hemoglobin optimization using intravenous iron, the cost of avoiding one patient transfusion was 831, and the cost of sparing one unit of red blood cells was 405, and the authors concluded that intravenous iron was cost effective in comparison with no optimization. One evidence-based guideline recommends intravenous iron before and after surgery for patients with iron deficiency anemia who are unable to tolerate or absorb oral iron, or unable to adhere to oral iron therapy, or the time interval between diagnosis of anemia and performance of surgery is too short for oral iron to be effective.