A Narrative Review of Erythropoietin Stimulating Agents for Trauma

Erythropoietin Stimulating Agents (ESAs), analogs of an endogenous hormone, have been extensively studied in clinical and research medicine since being made in a recombinant form over forty years. They have several indications for chronic anemia. In the critically injured trauma population, ESAs have been examined for their potential red blood cell transfusion-sparing effects. However, the literature to date does not support ESAs use in avoiding transfusion. Instead, the focus of their use has shifted to their extra-hematopoietic effects, which may reduce mortality and improve neurologic outcomes in severely injured patients. This narrative review aims to detail the current state of data on using ESAs in the major trauma population.

Our review followed the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews. The primary author used PubMed and Dynamed databases for terms related to erythropoietin (or ESAs) and the trauma population. Abstracts from peer-reviewed articles from 1999 to 2024 were screened for relevant material regarding the above criteria, followed by an article review if selected for inclusion.

We screened 582 studies, of which 46 met the inclusion criteria for this review. There were 9 RCTs, 24 meta-analyses/systematic reviews, 7 retrospective studies, 1 prospective observational study, and 4 preclinical/basic science articles were used. Of these, 12 demonstrated a potential benefit with the use of ESAs with improved mortality. There were 7 that demonstrated no increased adverse events.

Erythropoietin Stimulating Agents have been evaluated as a viable treatment option that may improve morbidity and mortality in patients with major trauma, particularly in the setting of traumatic brain injury and severe physical injury. This scoping review of 46 studies underscores the potential benefits of ESAs, indicating a need for further research.