Date Published: 
Friday, 1 August, 2014

Intravenous ferric carboxymaltose is more efficacious than oral ferrous glycine sulphate in correcting post-operative anaemia after total knee arthroplasty, new data indicates

Study results have revealed that treatment with i.v. ferric carboxymaltose is associated with a more frequent correction of post-operative anaemia than oral treatment with ferrous glycine sulphate.

Post-operative anaemia is common in patients undergoing major orthopaedic surgery such as total knee arthroplasty (TKA). The prolonged low Hb levels following major surgery has been associated with increased mortality and morbidity.

This prospective, single-blinded, randomised controlled trial compared the efficacy of post-operative i.v. ferric carboxymaltose and oral ferrous glycine sulphate in early improvement of anaemia following TKA and recovery from surgery. Out of 161 preoperatively non-anaemic patients , 122 developed anaemia in the 24 hrs following surgery and were included in this study; treatment consisted of either i.v. ferric carboxymaltose (single 700–1000 mg dose on post-operative day 2 according to the calculated iron deficit), or a once daily oral dose of ferrous glycine sulphate (100 mg iron from day of discharge to 30 days after surgery).

Before treatment initiation, patients experienced a significant decrease in mean Hb from 13.6 g/dL at enrolment to 10.5 g/dL 24 h after surgery (p<0.001 vs baseline). Over half (56.7%) of these patients were found to be iron deficient (ferritin <100 ng/mL).  At the end of the study period patients treated with i.v. iron achieved Hb ≥ 12.0 g/dL more frequently  compared with those treated with oral iron (42.3% vs 23.5%; p=0.04).

The authors highlighted that non-anaemic patients undergoing TKA are at high risk of post-operative anaemia, and that iron status should be actively assessed during orthopaedic surgery. Intravenous ferric carboxymaltose treatment resulted in a more frequent correction of post-operative anaemia than oral iron, and therefore was recommended for post-operative patient management.

The full article is available online ahead of print in British Journal of Anaesthesia. For information on iron deficiency, please click here.