Associazione Nazionale Medici Cardiologi Ospedalieri



Iron deficiency anemia after cardiac surgery: is there an added value of therapy with sucrosomial iron on top on ferric carboxymaltose? Preliminary data

Venturini elio Cecina(Livorno) – U.O.S: Riabilitazione Cardiologica area SUD, Azienda USl Toscana nord ovest. ospedale Civile di Cecina | Giallauria Francesco Napoli(Napoli) – Dipartimento di Scienze Mediche Traslazionali, Divisione di Medicina Interna ad Indirizzo Metabolico e Riabilitativo, Università Federico II Napoli |

Background: IDA after CS increases mortality, serious adverse events and length of stay; it also has a negative impact on the cardiac rehabilitation (CR) program. The FCM is the gold standard for IDA patients (P). However short-term treatment of IDA after CS using FMC or SI showed a significant similar improvement of key hematological parameters (HP) and in functional capacity . The aim of the study was to evaluate whether the use of both therapies had an additional positive effect.

Methods: 26 consecutive IDA P, (normal ventricular function, mean age 71,5 ± 8y), after the admission in in in-patient Cardiac Rehabilitation were all treated with FCM (group A) and a part (group B , n 13) also with SI. The study design included a single dose of 1000 mg of FCM at T1 (at 8-10 days from CS) and after a dose of 60 mg of SI per day from T1 to T2 (the day of discharge 10 days after ) until T3 , 15 days after. Measures of efficacy included changes from baseline in HP and natriuretic peptides (NP) .

Results:. the data are shown in the Table. The statistical analysis was conducted with the Mann Whitney test (non-parametric). At baseline there were no differences in Vit B12, folate and reticulocytes. No P had a deficiency of Vit.B12 or of reticulocytes; 57% had a folate deficiency (higher prevalence in the group B, 4.0 ±2.1 vs. 9.5±11.7 ns). Hb and other HP increased significantly, with no differences between the two groups. The increase in Transferrin Saturation (Tsat) was greater (but ns) in group B with lower baseline level. The ferritin (F) level was much higher in group A; the delta is also significant. Iin group B the F remains stable, while in grupo A it doubles (+94%). No significant differences were observed in others parameters. The NP level was lower at T3 in group B; the data does not appear to be clinically relevant, for the different baseline values (the delta was not significant).

Conclusions: it is mandatory to look for folate deficiency, for optimal management of IDA after CS. The SI can mitigate the high levels of F, consequence of the inflammatory state following CS. Furthermore , it is known that FCM can induce a further increase in F may be due to a low-grade pro-inflammatory effect correlated to the high level of iron deposition in macrophages . Also relevant is the positive impact on TSAT with the possibility of reaching the guidelines-level more quickly. The increase in the number of cases will allow us to achieve more certain results.