Intravenous ferric derisomaltose for preoperative anemia in abdominal surgery

There is increasing evidence supporting the use of intravenous (IV) iron in the perioperative setting, which has been shown to improve hemoglobin levels and reduce the need for transfusion. This study aimed to evaluate the efficacy of a single preoperative IV infusion of ferric derisomaltose administered 3 to 4 weeks prior to abdominal surgery in increasing hemoglobin (Hb) levels.

This single arm prospective trial with pos-hoc matched controls included adult patients with preoperative iron deficiency anemia (Hb ≤ 12 g/dL, and ferritin<30 ng/mL or transferrin saturation < 20 %) scheduled for abdominal surgery and treated with 1000 mg of IV ferric derisomaltose 3-4 weeks prior to surgery. The primary outcome was the change in Hb from baseline to the day of surgery. Between-group comparisons were performed using the paired t-test. A random control cohort who met our inclusion criteria but did not receive the treatment was included in a post-hoc analysis to evaluate associations with in-hospital blood transfusion.

Among 36 patients treated with IV ferric derisomaltose, there was a significant improvement in hemoglobin levels after 3-4 weeks of drug administration (mean difference [MD] 1.88 g/dL, 95 % confidence interval [CI] 1.40 to 2.36) and after surgery (MD 0.67 g/dL, 95 %CI 0.16 to 1.17). Patients with moderate-to-severe pre-infusion anemia (Hb ≤ 10 g/dL) had a significantly superior improvement in Hb levels compared to patients with mild anemia (P = 0.03). In post-hoc analysis including a control group, transfusion rate was similar between the treated and control group (odds ratio 1.00, 95 %CI 0.29-3.48).

In this preliminary report with limited sample size, our findings suggest that a single preoperative dose of 1000 mg of IV ferric derisomaltose improves hemoglobin levels. Its ability to provide timely optimization before surgery warrants further investigation in large-scale trials to better define its role in perioperative care.