Epoetin Alfa May Improve Trauma Patient Survival

Although treatment with epoetin alfa does not reduce the need for red-cell transfusion in critically ill patients and may raise the risk of thrombotic events, it may improve survival, especially in trauma patients, a new study suggests.

Researchers from Dartmouth-Hitchcock Medical Center (Lebanon, NH, USA) followed 1,460 critically ill patients who were randomized to receive weekly injections of epoetin alfa (40,000 units) or placebo for three weeks. The subjects were followed for 140 days; the main outcome was the percentage of patients who required red-cell transfusion.

The results showed that epoetin alfa use did not reduce the likelihood of transfusion nor did it reduce the number of transfusions. However, hemoglobin levels at day 29 were significantly higher in the active treatment group. A trend toward lower mortality at day 29 was seen among patients given epoetin alfa. The benefit was most apparent in trauma patients, who had a 63% and 60% reduction in mortality at day 29 and 140, respectively. Epoetin alfa use was tied to an elevated risk of thrombotic events; patients given the agent were 41% more likely to experience an adverse event than those given placebo. The study was published in September 6, 2007, issue of The New England Journal of Medicine (NEJM).

"In contrast to our earlier studies, we did not find a reduction in transfusion, likely due to a change in transfusion practice,” said lead author Dr. Howard L. Corwin. The researchers say that the findings suggest that there may be non-hematopoietic actions of epoietin that are important in the intensive care unit (ICU) as well as other clinical settings.

Epoetin alfa is in a class of medications called erythropoiesis-stimulating agents (ESAs), which work by stimulating the bone marrow to make more red blood cells. Epoetin alfa is used to treat anemia in patients with chronic kidney failure, to treat anemia in people receiving certain medications--such as chemotherapy and medication used to treat human immunodeficiency virus (HIV)--and is also used before and after certain types of surgery to decrease the number of blood transfusions needed.


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Dartmouth-Hitchcock Medical Center