Erythropoietin Therapy After Cardiac Arrest
What is the benefit of a high dose of erythropoietin (Epo) analogs in patients with out-of-hospital cardiac arrest?
The investigators performed a multicenter, single-blind, randomized controlled study in which patients comatose after cardiac arrest were randomized to standard care versus standard care plus high-dose Epo started immediately on enrollment and continued for 48 hours. The primary endpoint was survival with no or minimal neurological impairment at 60 days (Cerebral Performance Category scale, level 1).
The trial enrolled 476 patients. There was no difference in the primary endpoint at 60 days (32% vs. 32%), or in mortality (58% vs. 56%, p = 0.85). There was an increase in serious adverse complications (23% vs. 15%, p = 0.03) in the Epo arm, with an especially increased risk of thrombotic complications (12% vs. 6%, p = 0.01). Epo was associated with both increased occurrence of deep-vein thrombosis as well as of coronary stent thrombosis.
In patients with out-of-hospital cardiac arrest, use of EPO did not result in improved neurological outcome and was associated with increased risk of thrombotic complications.
EPO has demonstrated remarkable benefits in animal models of cardiac or neurological injury, but randomized trials testing this therapy in the setting of myocardial infarction, stroke, and cardiac arrest have not only failed to demonstrate a benefit, but have raised concerns about increased risk of thrombotic complications. Based on these results, there is no clinical role for Epo in this population.
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