Intravenous Iron for Anemia before Elective Cardiac Surgery

Approximately one third of all cardiac surgery patients are anemic, and preoperative anemia increases risks of blood transfusions, complications, and mortality. Since iron deficiency is the most common cause of anemia, researchers randomized 955 anemic adults (Hb<130 g/L; mean age, 66 years; 60% male) undergoing elective cardiac surgery at 33 hospitals in 10 countries to receive either 1000 mg intravenous iron (n=475) or a saline placebo (n=480) between 1 – 26 weeks before surgery. Compared to patients who received placebo, patients who received intravenous iron had higher hemoglobin levels by 3.8 g/L on the day of surgery (a median of 28.7 days after either iron or placebo). In addition, among patients who received iron, fewer needed RBC transfusions during the surgery compared to those who received placebo; 61% of patients who received iron were transfused with RBCs compared to 68% of those who received placebo (relative risk 0.90, 95% C.I., 0.82 to 0.99; P=0.027). The researchers estimated that intravenous iron injections prior to elective cardiac surgery saved approximately 44 units of RBCs per 100 patients. Lengths of hospital and ICU stays were similar in both arms as were rates of death, myocardial infarctions, and strokes. Intravenous iron injections before elective cardiac surgery in anemic patients is an effective strategy to improve hemoglobin levels and reduce blood use.

Reference:

Myles PS, Klein AA, Smith JA, Wallace S, et al; Australian and New Zealand College of Anaesthetists Clinical Trials Network and the ITACS investigators. Intravenous iron to treat anaemia before cardiac surgery (ITACS): international, double blind, placebo controlled randomised trial. BMJ. 2026 Aug 19;394:e100407. doi: 10.1136/bmj-2026-100407.