| ВХОД ДЛЯ ПАЦИЕНТОВ
|Re: Эритропоэтин при травме?
послал Karim Brohi 19 Апрель 2004, 23:48
|Currently there hasn't been a RCT of erythropoietin in trauma patients.
However there is a randomized double-blind controlled trial of EPO in critically ill patients (JAMA 2002) which I've posted below. Basically this multicenter study randomized 1302 patients to EPO or placebo on ICU day 3 and continued weekly for 3 doses while the patients remained in hospital.
The primary endpoint for the study was transfusion independence, and they found EPO patients were less likely to receive a transfusion (60.4% placebo vs 50.5% rHuEPO; P<.001). Patients on EPO also received less transfusions and had a greater increase in haemoglobin from baseline. There was no difference in mortality or morbidity between the two groups.
In the fine print is that the transfusions saved amounted to approximately 1 unit of transfusion per patient, and this was over the whole hospital stay and not the ICU stay. Is this clinically significant? Probably not for the individual patient. But if each patient was saved 1 unit of blood then 650 units of blod were saved over the study, which does become significant, both from a cost and risk issue.
Is EPO indicated in trauma patients. Probably there is a group of patients who would benefit. Those long-term ICU patients who have to get topped up once or twice a week due to fluid administration, phlebotomy, 'critical illness anaemia' etc. The study needs to be done.
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