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Arthroplasty: A. F. C. M. Moonen, B. J. W. Thomassen, N. T. Knoors, J. J. van Os, A. D. Verburg, and P. Pilot Pre-operative injections of epoetin- versus post-operative retransfusion of autologous shed blood in total hip and knee replacement: A PROSPECTIVE RANDOMISED CLINICAL TRIAL J Bone Joint Surg Br 2008; 90-B: 1079-1083 [Abstract] [Full text] [PDF]

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Is epoetin really a viable option?

Lydia K Milnes, Koushik Ghosh, Ziad Harb   (14 August 2008)

Is epoetin really a viable option? 14 August 2008
Lydia K Milnes, SHO Orthopaedics St George's Hospital, Tooting, Koushik Ghosh, Ziad Harb Send letter to journal: Re: Is epoetin really a viable option? lydia_milnes{at}hotmail.com Lydia K Milnes, et al.	Sir, We read this paper with interest and acknowledge the relevance and power of the trial. However, there are several issues that we would like to raise. Firstly, although the complication rate between the groups is said to be similar, no specific mention is made of thromboembolism. This is a relevant negative that should have been commented on, particularly in view of well-documented evidence that epoetin is strongly associated with an increased risk of venous thromboembolism and mortality.1 Secondly, given that the annual incidence of cerebral sinus thrombosis is three to four cases per million in adults,2 can the authors confidently dismiss their incidence of one in 50 as unrelated to the treatment given? Thirdly, the FDA recommends that erythropoetin-stimulating agents should not be used in patients whose Hb level exceeds 12g/dl and should only be considered if the Hb falls below 11g/dl.3 Although this relates to cancer patients, how did the authors arrive at their cut-off point of 13g/dl? L.K. Milnes, SHO Orthopaedics, K. Ghosh, Z. Harb, St George's Hospital, Tooting, London, UK. 1. Bennett CL, Silver SM, Djulbegovic B, et al. Venous thromboembolism and mortality associated with recombinant erythropoietin and darbepoetin administration for the treatment of cancer-associated anemia. JAMA 2008;299:914-24. 2. Einhäupl K, Bousser MG, de Bruijn SF, et al. EFNS guideline on the treatment of cerebral venous and sinus thrombosis. Eur J Neurol 2006;13:553–9. 3. Khuri FR. Weighing the hazards of erythropoiesis stimulation in patients with cancer. N Engl J Med 2007;356:2445-8.