Pre-op iron infusions could improve heart surgery recovery

Intravenous (IV) iron infusions given to patients with anaemia before heart surgery could reduce the need for blood transfusions and lead to improved recovery, a new study found.

The international clinical trial - the largest of its kind – co-led by Professor Toby Richards at the University of East London (UEL) and involved 955 patients across 33 hospitals in 10 countries, who undertook a double-blind, placebo-controlled randomised study.

The findings, published by The BMJ, show that patients who received IV iron infusions ahead of their operations were less likely to require blood transfusions during their hospital stay compared to those who received a placebo (61.1% vs 68.2%). This saved around 44 units of blood products for every 100 patients treated.

Patients who were part of the iron group also saw an improvement in the number of days alive and at home in the first 90 days post-surgery (81.1 days vs 80.0 days for the placebo group).

These findings provide compelling evidence that it is time to rethink our position regarding patients with anaemia and promotes the routine use of IV iron infusions for patients.

Current NICE guidance recommends oral iron as the first-line treatment for iron-deficiency anaemia, with referral to specialist clinics when this is ineffective. However, across a stretched NHS, access to these specialist services is far from straightforward. We need to make IV iron infusions available and accessible to patients from primary care.

Routine early screening for anaemia and iron deficiency must become a standard part of pre-surgical care, giving patients the best chance of receiving timely, effective treatment before surgery.”

- Toby Richards, Professor of Surgery at UEL

As between 20% to 40% of patients undergoing cardiac surgery suffer from anaemia, which heavily increases their risk of requiring blood transfusions - a factor linked to worse postoperative outcomes including prolonged ventilation and higher mortality rates - the researchers advise that national guidelines should be updated to recommend iron supplementation prior to surgery.