Considerations for Practice

The phenomenon of ischaemic preconditioning (IPC) is clinically very important, being involved in the potential protection of myocardium during cardiac surgery or percutaneous invasive procedures. However, its precise mechanisms have not yet been established. It is commonly known that patients with either diabetes or heart failure do not benefit from IPC in a similar extent to subjects without these metabolic pathologies.

Iron deficiency is the leading cause of preoperative anaemia, a frequent condition amongst patients undergoing major orthopaedic surgery1. Preoperative anaemia is associated with increased risk of postoperative mortality and morbidity, nosocomial infection, and prolonged hospitalisation1–4. Perioperative blood loss and blunted erythropoiesis due to surgery-induced inflammation, may lead to postoperative anaemia in almost 90% of procedures5.

Two clinical trials have reported positive top-line results for their respective therapies, ferric carboxymaltose and soluble ferric pyrophosphate, in patients with chronic kidney disease, according to recent press releases. Together, these trials demonstrate the central role of iron across the chronic kidney disease spectrum, with benefits of iron therapy reported in dialysis and non-dialysis-dependent patient populations.

Ferric carboxymaltose assessment in subjects with iron deficiency anaemia and non-dialysis-dependent CKD (the FIND-CKD study)

Intravenous iron therapy reduces symptoms for patients with chronic heart failure irrespective of anaemia, according to a subanalysis. The study indicates that iron status should be assessed in symptomatic patients with chronic heart failure both with and without anaemia, and that treatment of iron deficiency should be considered in both patient populations.

Clinical studies suggest that a total dose infusion (TDI) of 1 g of intravenous (IV) iron is a suitable iron replacement approach compared with multiple small-dose infusions for patients with iron deficiency1–3. In the last decade, evidence has been published demonstrating safety, efficacy and, particularly, convenience of rapid administration of 1000–1500 mg of IV iron1–4.

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