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Preoperative Erythropoietin vs Placebo

What Does the Latest Meta-analysis Say?

Nathan, Naveen, MD

doi: 10.1213/ANE.0000000000004150
Infographics: Infographic

Northwestern University Feinberg School of Medicine (

Published ahead of print 26 February 2019.

The Infographic is composed by Naveen Nathan, MD, Northwestern University Feinberg School of Medicine ( Illustration by Naveen Nathan, MD.

The author declares no conflicts of interest.



This infographic illustrates the results of a systematic review and meta-analysis on the effect of preoperative erythropoietin on perioperative blood transfusion. Cho et al1 analyzed 32 randomized controlled trials incorporating more than 4700 patients who either received erythropoietin (EPO) or placebo. Preoperative EPO significantly decreased the use of allogeneic blood across many types of surgery, including orthopedic and cardiac cases. The latter showed evidence of almost a 50% reduction. The rate of thrombotic complications (a risk of erythropoietin notably characterized by an FDA-imposed black box warning) was not different between groups, although the P value for significance in this regard was only .68. Interpretation of the results of this analysis must recognize the heterogeneity of study populations, variation in EPO dosing, and other limitations that the reader is encouraged to explore in the original article.

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1. Cho BC, Serini J, Zorrilla-Vaca A, et alImpact of preoperative erythropoietin on allogeneic blood transfusions in surgical patients: results from a systematic review and meta-analysis. Anesth Analg. 2019;128:981992.
© 2019 International Anesthesia Research Society