Perioperative Iron With Erythropoietin in Bilateral Total Knee Replacement Arthroplasty (TKRA) (SNUBH)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01012063
Recruitment Status : Completed
First Posted : November 11, 2009
Last Update Posted : August 19, 2013
Information provided by (Responsible Party):
Hyo-Seok Na, Seoul National University Bundang Hospital

Brief Summary:
The object of this study is to evaluate whether low dose intravenous iron and erythropoietin (Epo) can decrease transfusion requirement after the bilateral TKRA.

Condition or disease Intervention/treatment Phase
Anemia Transfusion Drug: iron sucrose, erythropoietin-β Drug: normal saline Not Applicable

Detailed Description:

Total knee replacement arthroplasty (TKRA) in severe osteoarthritis usually requires extensive soft tissue and bone dissection associated with substantial bleeding. Because TKRA is performed with a pneumatic tourniquet, intraoperative bleeding is not substantial, however, over 80% of the total blood loss occurs within the first 24 hour after the operation and the hidden blood loss is 50% of the total loss, making the true blood loss twice. Consequently, many patients can become anemic at early postoperative period and this anemic condition may lead to overall physical deterioration which include fatigue, dizziness, reduced exercise tolerance and delayed recovery.

Therefore, many patients frequently received the autologous or allogenic blood transfusion. In order to reduce the allogenic blood transfusion (ABT), various methods have been used, such as preoperative autologous blood donation (PABD), use of pharmacologic agents, iron or erythropoietin (Epo) and postoperative blood salvage. All of the above methods have been proved to reduce the ABT effectively6, without increase in cost.

Iron and Epo have been used widely in a variety of clinical situations instead of allogenic RBC transfusion. They also have been used for augmenting PABD or improving preoperative hemoglobin (Hb) level. However, there still remains a controversy about the efficacy of the method on the postoperative anemia. We think that these various results may be related with individual iron state of the patients and dose of drug or timing of drug application.

In this trial, iron and Epo are planned to be administered to the iron deficient non anemic patients during the operation and once again after surgery.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 54 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Perioperative Intravenous Iron With Erythropoietin for the Prevention of Postoperative Severe Anemia and Reduction of Transfusion in Bilateral Total Knee Replacement Arthroplasty
Study Start Date : August 2008
Actual Primary Completion Date : October 2009
Actual Study Completion Date : October 2009

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: group IE
The group IE received iron sucrose and erythropoietin-β (Epo-β) during the operation
Drug: iron sucrose, erythropoietin-β
The 200 mg of iron sucrose diluted with 100 ml of normal saline was given intravenously over one hour and the 3000 IU of Epo-β was injected subcutaneously.
Other Names:
  • Venoferrum
  • recormon
Placebo Comparator: group C
The group C received saline as same method.
Drug: normal saline
100 ml of normal saline was given intravenously over one hour and 0.5ml was injected subcutaneously.
Other Name: sodium chloride

Primary Outcome Measures :
  1. postoperative hemoglobin [ Time Frame: postoperative 1, 2, 3, 5 day and 2, 6 week ]

Secondary Outcome Measures :
  1. serum iron, ferritin, total iron binding capacity (TIBC) and transferrin saturation (TSAT) [ Time Frame: preoperation and postoperation ]

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Ages Eligible for Study:   50 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Female patients undergoing bilateral total knee replacement arthroplasty
  • American society of anesthesiologist class 1-3
  • Hb>100 g/L
  • Either serum ferritin<100 ng/ml or 100<ferritin<300 ng/ml with a transferrin saturation (TSAT) <20%

Exclusion Criteria:

  • Hematologic disease
  • Thromboembolic disease
  • Hepatic or renal disease
  • Coagulation disorder
  • Infection
  • Malignancy
  • Under anticoagulant therapy
  • Hypersensitivity to iron sucrose or Epo
  • Preoperative autologous blood donation
  • Use of iron or Epo and blood transfusion within the previous 1 month

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01012063

Korea, Republic of
Seoul National University Bundang Hospital
Seongnam, Gyeonggi, Korea, Republic of, 463-707
Sponsors and Collaborators
Seoul National University Bundang Hospital
Principal Investigator: Hyoseok Na, pf Seoul National University Bundang Hospital

Responsible Party: Hyo-Seok Na, Dr., Seoul National University Bundang Hospital Identifier: NCT01012063     History of Changes
Other Study ID Numbers: B-0905/076-005
First Posted: November 11, 2009    Key Record Dates
Last Update Posted: August 19, 2013
Last Verified: August 2013

Keywords provided by Hyo-Seok Na, Seoul National University Bundang Hospital:
Total knee replacement arthroplasty

Additional relevant MeSH terms:
Hematologic Diseases
Ferric oxide, saccharated
Epoetin Alfa
Ferric Compounds
Trace Elements
Growth Substances
Physiological Effects of Drugs