- Design
- International, double-blind, placebo-controlled randomised trial
- Population
- 955 adults with anaemia undergoing elective cardiac surgery, 33 hospitals
- Primary outcome
- Days alive and at home at 90 days
- Effect
- 81.1 vs 80.0 days, difference 1.0 (95.4% CI 0.0–2.1); transfusion 61.1% vs 68.2%, RR 0.90 (95% CI 0.82–0.99)
ITACS randomised 955 adults with anaemia awaiting elective cardiac surgery at 33 hospitals in 10 countries to 1000 mg of intravenous iron or placebo, given 1 to 26 weeks before surgery. The trial was double-blind. The primary outcome was days alive and at home by 90 days after surgery.
Patients who received iron had a median of 81.1 days alive and at home against 80.0 with placebo, an adjusted difference of one day. Red cell transfusion during the admission fell from 68.2% to 61.1%. Major complications and length of stay did not differ.
The gains are modest, but the intervention is simple and the transfusion reduction is real. Anaemia before major surgery is common and often untreated simply because nobody checks early enough. The practical lesson reaches beyond cardiac surgery: find and treat anaemia weeks before an elective operation, not on the day of admission.
- Check haemoglobin and iron studies when a patient is listed for major elective surgery
- Treat iron deficiency weeks before surgery, not days
- Consider intravenous iron where oral iron is too slow or poorly tolerated
- Investigate the cause of iron deficiency rather than only replacing it
Why it matters
Preoperative anaemia is a treatable risk that is often found too late to act on.
Don't overread it
One extra day at home out of 90 is statistically significant but small; the trial did not reduce complications.
The statistics, in plain English
A transfusion relative risk of 0.90 (95% CI 0.82–0.99) means about 10% fewer patients were transfused — roughly 7 per 100 treated. The primary result of one extra day at home (95.4% CI 0.0 to 2.1) only just reached significance and is small in clinical terms.
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