Erythropoietin in the clinical trials of the cardiac disease, what is and what is not

Erythropoietin (Epo) is the main erythropoiesis hormone, activate the progenitor red blood cells through proliferation, differentiation and maturation of red blood cells. However, it's another receptor in other tissues, including heart and endothelium, confirm its pluripotent activities. A numerous preclinical studies have shown Epo would be cardioprotective against ischemic events, reperfusion injury and apoptosis. The results of Epo in clinical studies were inconclusive with even associated increased risk of adverse outcomes. In this article, a comprehensive review of the Epo effects is evaluated in the coronary artery disease, cardiac surgery, heart failure and its safety through the results of the most recent clinical trials related to Epo in the cardiovascular disease. The analysis of the available clinical trials demonstrates the most determining factors; Epo dose and administration time related to myocardial ischemia onset. It seems the low dose Epo treatment has tissue protective effect through its receptors, while the higher doses of Epo stimulates the other Epo receptors responsible for erythropoiesis. The safety of high dose Epo therapy to increase risk of thrombotic complications has been controversial. The erythropoiesis-stimulating agents have been proven to successfully correct hemoglobin levels, reduce the need to blood products after surgery and can improve the clinical outcomes, without an increased thromboembolic risk

Increased Demand for Blood Transfusion in Cardiac Surgery: Simple but Unsolved Common Problem

Background: Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago.Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center.Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P<0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfusion, compared to those who did not, in both groups. With compared to the past, the patients are older, have less preoperative hematocrit, more diabetic, more need to intra-aortic balloon pump, shorter operation time, and less postoperative bleeding .Conclusion: With advanced knowledge about transfusion complications and conservative approach to transfusion practice, the need to blood transfusion is increased in current cardiac operations in our center, due to association of more co-morbidities