QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Résumé Extracto Full Text PDF Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Articles Ahead of Print [Order Reprint] Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pajoumand, M. Articles by Camamo, J. M Search for Related Content PubMed PubMed Citation Articles by Pajoumand, M. Articles by Camamo, J. M

THERAPEUTIC CONTROVERSIES

Use of Epoetin Alfa in Critically Ill Patients

Critical Care Specialty Resident, University of Kentucky Chandler Medical Center, Lexington, KY

Brian L Erstad, PharmD FCCM

Associate Professor, Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson, AZ

James M Camamo, PharmD

Clinical Specialist in Drug Information, Department of Pharmacy Services, University Medical Center, Tucson

Reprints: Brian L Erstad PharmD FCCM, Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, PO Box 210207, Tucson, AZ 85721-0207, fax 520/626-4063, erstad{at}pharmacy.arizona.edu

OBJECTIVE: To discuss the controversies regarding the use of epoetin alfa (EPO) for reducing red blood cell (RBC) transfusions in critically ill patients with anemia.

DATA SOURCES: A MEDLINE search (1966–July 2003) was conducted using the search terms anemia; critical illness; erythropoietin; epoetin alfa; and erythropoietin, recombinant. References of selected articles were reviewed for studies that may have been missed by the computerized search.

STUDY SELECTION AND DATA EXTRACTION: Studies pertaining to the use of EPO for anemia of critical illness with an emphasis on data obtained from controlled trials.

DATA SYNTHESIS: Anemia is a common complication in patients admitted to the intensive care unit (ICU). Two prospective, randomized studies have demonstrated decreased transfusion requirements associated with EPO administration in medical/surgical patients who were in the ICU for at least 3 days and had hematocrit concentrations <38%. No differences were found in length of stay or mortality. A multicenter trial found that a restrictive strategy of RBC transfusion (hemoglobin goal 7–9 g/dL) was associated with in-hospital mortality lower than that with a more liberal approach, which calls into question the 38% hematocrit goal in the EPO trials. Furthermore, preliminary results from an economic analysis of EPO use in the ICU setting have demonstrated that EPO is not cost-effective.

CONCLUSIONS: Given the controversies surrounding EPO administration in critically ill patients, institutions are encouraged to develop EPO guidelines to help ensure the most appropriate use of this expensive product. Additional studies regarding patients most likely to benefit from EPO therapy, the most effective dosing regimen, and use of adjunctive therapies are needed.

Key Words: anemia, blood transfusion, erythropoietin

Published Online, February 13, 2004. www.theannals.com, DOI 10.1345/aph.1D368

This article has been cited by other articles:

				M. Darveau and E. Notebaert Comment: use of epoetin alfa in critically ill patients Ann. Pharmacother., July 1, 2004; 38(7): 1325 - 1326. [Full Text] [PDF]