Evidence map›Paper›PMID 31036337›Full record

Trial reportLancet (London, England)2019

Effect of ultra-short-term treatment of patients with iron deficiency or anaemia undergoing cardiac surgery: a prospective randomised trial.

Donat R Spahn, Felix Schoenrath, Gabriela H Spahn, Burkhardt Seifert, Philipp Stein, Oliver M Theusinger, Alexander Kaserer, Inga Hegemann, Axel Hofmann, Francesco Maisano and 1 more

4 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Lancet (London, England), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 4 registered trials, which are not on this map. Cited by 128 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
128citing papers in PubMed, 7 pooled it
19.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02031289 phase4completednot on this map

Impact of Preoperative Treatment of Anemia and Iron Deficiency in Cardiac Surgery on Outcome.

TypeinterventionalSponsorUniversity of ZurichRan2013 to 2018Enrolled1,003ConditionsAnemia, Iron DeficiencyArmsErythropoietin/Ferric carboxymaltose/Vitamin B12/Folic Acid
NCT04744181 completednot on this mapstarted 2021, after this paper: background citation

Patient Blood Management In CARdiac sUrgical patientS: the ICARUS Study

TypeobservationalSponsorFondazione Policlinico Universitario Agostino Gemelli IRCCSRan2021 to 2022Enrolled479ConditionsAnemia, Blood Loss Anemia, Iron-deficiency, Iron Deficiency AnemiaArmsFerric carboxymaltose, B vitamin, Folic acid
NCT06012760 narecruitingnot on this mapstarted 2025, after this paper: background citation

Effect of Iron Sucrose Combined With Human Erythropoietin and Vitamin C on Perioperative Allogeneic Red Blood Cell Infusion in Major Cardiac Surgery

TypeinterventionalSponsorSecond Affiliated Hospital, Zhejiang University, School of MedicineRan2025 to 2028Enrolled400ConditionsAnemia, Iron Deficiency Anemia, Perioperative, TransfusionArmsIron sucrose, Human Erythropoietin Injection, Vitamin C, Standard Medical Care
NCT06968936 narecruitingnot on this mapstarted 2026, after this paper: background citation

Long-term Outcomes Sub-Study of Preoperative Combined Iron Therapy in Anemic Patients Undergoing Cardiac Surgery: A Randomized Controlled Trial

TypeinterventionalSponsorSecond Affiliated Hospital, Zhejiang University, School of MedicineRan2026 to 2029Enrolled400ConditionsAnemia, Iron Deficiencies, Cardiac SurgeryArmsSucrose Iron，subcutaneous recombinant human erythropoietin，intravenous vitamin C, Routine perioperative management
3 · Its place in the literature

Who cites it

128 citing papers in PubMed, 7 syntheses or guidelines pooled it, 367 citations in OpenAlex.

  1. Pooled it
  2. Preoperative anemia and anemia treatment in cardiac surgery: a systematic review and meta-analysis.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Article
  10. Observational
  11. Review
  12. Article
  13. Article
  14. Review
  15. Role of Micronutrients in Perioperative Care: A Systematic Review.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2026
    Article
  16. Article
  17. Review
  18. Article
  19. Review
  20. The untransfusable patient.Hematology. American Society of Hematology. Education Program · 2025
    Review

68 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 4 institutions in 3 countries.

Donat R SpahnInstitute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland. Electronic address: donat.spahn@usz.ch.
Felix SchoenrathDepartment of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Germany.
Gabriela H SpahnInstitute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Burkhardt SeifertDepartment of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland.
Philipp SteinInstitute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Oliver M TheusingerDepartment of Anaesthesiology, University of Zurich and University Hospital Balgrist, Zurich, Switzerland.
Alexander KasererInstitute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Inga HegemannDivision of Haematology, University of Zurich and Zurich University Hospital, Zurich, Switzerland.
Axel HofmannInstitute of Anaesthesiology, University of Zurich and University Hospital Zurich, Zurich, Switzerland; School of Surgery, University of Western Australia and School of Public Health Research, Curtin University, Perth, Western Australia, Australia.
Francesco MaisanoDepartment of Cardiovascular Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Volkmar FalkDepartment of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Berlin, Germany; Department of Cardiothoracic Surgery, Charité - Universitätsmedizin Berlin Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
University of Zurich · CHDeutsches Herzzentrum München · DEUniversity Hospital of Zurich · CHCurtin University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAnaemia and iron deficiency are frequent in patients scheduled for cardiac surgery. This study assessed whether immediate preoperative treatment could result in reduced perioperative red blood cell (RBC) transfusions and improved outcome.

methodsIn this single-centre, randomised, double-blind, parallel-group controlled study, patients undergoing elective cardiac surgery with anaemia (n=253; haemoglobin concentration (Hb) <120 g/L in women and Hb <130 g/L in men) or isolated iron deficiency (n=252; ferritin <100 mcg/L, no anaemia) were enrolled. Participants were randomly assigned (1:1) with the use of a computer-generated range minimisation (allocation probability 0·8) to receive either placebo or combination treatment consisting of a slow infusion of 20 mg/kg ferric carboxymaltose, 40 000 U subcutaneous erythropoietin alpha, 1 mg subcutaneous vitamin B12, and 5 mg oral folic acid or placebo on the day before surgery. Primary outcome was the number of RBC transfusions during the first 7 days. This trial is registered with ClinicalTrials.gov, number NCT02031289.

findingsBetween Jan 9, 2014, and July 19, 2017, 1006 patients were enrolled; 505 with anaemia or isolated iron deficiency and 501 in the registry. The combination treatment significantly reduced RBC transfusions from a median of one unit in the placebo group (IQR 0-3) to zero units in the treatment group (0-2, during the first 7 days (odds ratio 0·70 [95% CI 0·50-0·98] for each threshold of number of RBC transfusions, p=0·036) and until postoperative day 90 (p=0·018). Despite fewer RBC units transfused, patients in the treatment group had a higher haemoglobin concentration, higher reticulocyte count, and a higher reticulocyte haemoglobin content during the first 7 days (p≤0·001). Combined allogeneic transfusions were less in the treatment group (0 [IQR 0-2]) versus the placebo group (1 [0-3]) during the first 7 days (p=0·038) and until postoperative day 90 (p=0·019). 73 (30%) serious adverse events were reported in the treatment group group versus 79 (33%) in the placebo group.

interpretationAn ultra-short-term combination treatment with intravenous iron, subcutaneous erythropoietin alpha, vitamin B12, and oral folic acid reduced RBC and total allogeneic blood product transfusions in patients with preoperative anaemia or isolated iron deficiency undergoing elective cardiac surgery.

fundingVifor Pharma and Swiss Foundation for Anaesthesia Research.

Indexed as

Administration, IntravenousAdministration, OralAgedAged, 80 and overAnemia, Iron-DeficiencyCardiac Surgical ProceduresDouble-Blind MethodDrug Therapy, CombinationErythrocyte TransfusionErythropoietinFemaleFerric CompoundsFolic AcidHeart DiseasesHumansMaleErythropoietinferric carboxymaltoseFerric CompoundsFolic AcidMaltoseVitamin B 12

Identifiers

PMID31036337
OpenAlexW2941111272

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.