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Evidence Does Not Support Erythropoietin Use in Critically Ill Patients: Presented at CCCF By Pam Harrison TORONTO, CANADA -- November 2, 2007 -- Evidence is insufficient to support the use of erythropoietin in critically ill patients, as it does not appear to decrease mortality or improve any clinically meaningful outcomes, according to a meta-analysis presented here at the Critical Care Canada Forum (CCCF). Ryan Zarychanski, MD, Research Fellow, Department of Epidemiology and Community Medicine, University of Ottawa, and Ottawa Health Research Institute, Ottawa, Ontario, Canada, and colleagues carried out a systematic review to investigate the clinical benefits and harms associated with the use of erythropoietin-receptor agonists (ERAs) in critically ill patients. Nine studies met eligibility criteria in the study, which compared ERAs with either placebo or no intervention. Investigators included only randomised controlled trials in their analysis and altogether involved 3,326 adults admitted to an ICU. It is noteworthy that iron was administered as a cointervention in all the studies. Analysis revealed that the use of erythropoietin was not associated with a statistically significant reduction in the overall all-cause mortality rate compared with placebo or no intervention (Odds Ratio [OR] = 0.86). Looking at clinically meaningful endpoints, no study found any significant differences in either ICU or hospital length of stay between patients receiving an ERA versus placebo or no intervention. Similarly, no significant differences in the duration of mechanical ventilation were detected between the treatment group and the groups on placebo or no intervention. The pooled OR for the occurrence of deep vein thrombosis associated with ERA use was also higher at 1.32 compared with patients with no ERA treatment, the investigators said. Importantly, the 2.1% incidence of myocardial infarction was higher in the ERA group compared with 0.8% of placebo/no-intervention controls. However, ERA use reduced the odds of a patient having to receive red blood cell transfusion by approximately 27% (OR = 0.73) relative to controls. The mean number of units of blood transfused per patient was also decreased by 0.41 units in ERA recipients, although most of the studies included in the analysis were done before widespread adoption of a restrictive transfusion strategy, the authors noted. Given the available evidence, "widespread use of erythropoietin is not recommended in critically ill patients," they concluded. [Presentation title: Erythropoietin Receptor Antagonists in Critically Ill Patients: Meta Analysis of RCTs.] E-mail this page to a friend or colleague! To print, use this version