The Preoperative Use of Erythropoietin Stimulating Proteins Prior to Radical Prostatectomy Is Not Associated With Increased Cardiovascular or Thromboembolic Morbidity or Mortality

ObjectivesTo critically examine the cardiovascular and thromboembolic risks associated with erythropoietin stimulating proteins (ESPs) in men with normal hemoglobin levels undergoing open radical retropubic prostatectomy.MethodsBetween October 1, 2000, through December 31, 2006, a total of 1308 men underwent open radial retropubic prostatectomy by a single surgeon. Of these men, 1095 received preoperative ESPs. Hematocrit levels measured at baseline, immediately before anesthesia induction and at hospital discharge, were prospectively entered into a database. Thromboembolic and cardiovascular complications were prospectively captured during the hospitalization and after surgery.ResultsThe mean Δ preoperative hematocrit level was 5.9 g/dL. The pre-anesthesia induction hematocrit level was 49.2%. Hospital discharge hematocrit level was 33.6 g/dL. The overall risk of cardiovascular and thromboembolic complications in men receiving ESP were 0.55% and 0.45%, respectively. The risk of cardiovascular and thromboembolic complications were independent of the Δ in preoperative hematocrit or the absolute level of the pre-anesthesia induction hematocrit.ConclusionsESPs represent a safe and effective preoperative blood management strategy for men undergoing open radical retropubic prostatectomy.