Date Published: 
Thursday, 23 October, 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 intravenous 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 haemoglobin 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 intravenous ferric carboxymaltose and oral ferrous glycine sulphate in early improvement of anaemia following TKA and recovery from surgery. Preoperatively non-anaemic patients (n=122) included in this study received either; ferric carboxymaltose the day after surgery as a single intravenous dose (700–1000 mg according to the calculated iron deficit on post-operative day 2), 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 haemoglobin 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 intravenous iron achieved haemoglobin ≥ 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 the British Journal of Anaesthesia. For information on iron deficiency, please click here.