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Barkovskaya N.A.

Privolzhsky Research Medical University;
Dzerzhinsk Perinatal Center

Shifman E.M.

Pirogov Russian National Research Medical University (RNRMU)

Protsenko D.N.

Pirogov Russian National Research Medical University (RNRMU);
Moscow’s Multidisciplinary Clinical Center “Kommunarka”

Katkova N.Yu.

Privolzhsky Research Medical University

Iron supplements and erythropoiesis-stimulating agents in intensive care of postpartum hemorrhage: a Bayesian network meta-analysis

Authors:

Barkovskaya N.A., Shifman E.M., Protsenko D.N., Katkova N.Yu.

More about the authors

Journal: Russian Journal of Anesthesiology and Reanimatology. 2025;(2): 59‑67

DOI: 10.17116/anaesthesiology202502159

Read: 1691 times

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Table of contents

IRON SUPPLEMENTS AND ERYTHROPOIESIS-STIMULATING AGENTS IN INTENSIVE CARE OF POSTPARTUM HEMORRHAGE: A BAYESIAN NETWORK META-ANALYSIS
IRON SUPPLEMENTS AND ERYTHROPOIESIS-STIMULATING AGENTS IN INTENSIVE CARE OF POSTPARTUM HEMORRHAGE: A BAYESIAN NETWORK META-ANALYSIS

To cite this article:

Barkovskaya NA, Shifman EM, Protsenko DN, Katkova NYu. Iron supplements and erythropoiesis-stimulating agents in intensive care of postpartum hemorrhage: a Bayesian network meta-analysis. Russian Journal of Anesthesiology and Reanimatology. 2025;(2):59‑67. (In Russ., In Engl.)
https://doi.org/10.17116/anaesthesiology202502159

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Abstract:

INTRODUCTION

The incidence of postpartum anemia ranges from 20 to 40%. Data on the use of erythropoietin for the treatment of postpartum anemia are limited.

OBJECTIVE

To quantify and rank the relative efficacy of different combinations of iron preparations and erythropoiesis-stimulating drugs in intensive care of postpartum hemorrhage.

MATERIAL AND METHODS

Biomedical databases were searched for studies investigating the efficacy of intravenous and/or oral iron preparations in combination with or without erythropoietin for the treatment of postpartum anemia. The comparison strategy is ferrotherapy with ferrous sulfate (SulfatFe). Primary endpoints: hemoglobin increment between baseline and after 5 and 14 days of treatment. Secondary endpoints: hematocrit, reticulocyte, blood ferritin, and transferrin saturation values at the same time points.

Design: systematic review, Bayesian random-effects network meta-analysis, augmented by a frequentist approach and network meta-regression.

RESULTS

The network meta-analysis included 6 studies, 279 patients. Compared with SulfatFe, the EPO_SulfatFe combination provided a significant increase in hemoglobin concentration at day 5: MD=9.01 g/L, 95% CrI (0.25; 18.90); evidence was insufficient for the other interventions. According to the values of area under the SUCRA cumulative ranking curve: best method EPO_SulfatFe (84.6%), followed by EPO_SucrosFe_SulfatFe (58.8%), SucrosFe_SulfatFe (54.3%), worst: Placebo_SucrosFe_SulfatFe (28.5%), SulfatFe (23.7%). On the 14th day, the EPO_SulfatFe combination showed the maximum increase in hemoglobin concentration: MD=10.00 g/L, 95% CrI (0.56; 19.70), ranked in the same order. The results of network meta-regression in this endpoint for total SulfatFe dose by day 14 of therapy are consistent with the estimates of the main meta-analysis.

CONCLUSIONS

The network meta-analysis demonstrated the feasibility of including erythropoiesis-stimulating drugs in the intensive care setting for postpartum hemorrhage. Further studies with sufficient sample sizes are needed, including high-dose iron preparations in combination with EPO.

Keywords:

postpartum hemorrhage
iron deficiency anemia
erythropoiesis-stimulating drugs
iron preparations
network meta-analysis
indirect comparison
mixed comparison

Authors:

Barkovskaya N.A.

Privolzhsky Research Medical University;
Dzerzhinsk Perinatal Center

Shifman E.M.

Pirogov Russian National Research Medical University (RNRMU)

Protsenko D.N.

Pirogov Russian National Research Medical University (RNRMU);
Moscow’s Multidisciplinary Clinical Center “Kommunarka”

Katkova N.Yu.

Privolzhsky Research Medical University

Received:

27.10.2024

Accepted:

07.11.2024

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