Is intravenous iron useful for reducing transfusions in surgically treated colorectal cancer patients?

BACKGROUND: The goal of the present study was to determine whether the intravenous administration of iron in the postoperative period of colon cancer surgical patients suffices to reduce the number of transfusions necessary. METHOD: The study was designed as a retrospective observational study conducted over a three-year period. A paired case-control design was used to analyze the effect of postoperative iron on patients' blood transfusion needs. Two groups were established (the case group, which received postoperative iron and the control group, which did not) and matched for age (± 3 years), gender, type of operation, tumor stage, and surgical approach. Of 342 patients who underwent operation, 104 paired patients were obtained for inclusion in this study (52 in each group). A second analysis was made to assess the effect of intravenous iron on the evolution of hemoglobin between the first postoperative day and hospital discharge in the subgroup of patients with reduction in hemoglobin, in subjects without preoperative or postoperative transfusions. Finally, a total of 71 patients were paired in two groups: 37 and 31 patients in case and control, respectively. RESULTS: The mean hemoglobin concentration at discharge for the case group was 10 ± 1.1 g/dl, vs. 10.6 ± 1.2 in the controls (P = 0.012). The number of transfusions in the case group was 3 ± 1.6, vs. 3.3 ± 3 in the control group (P = 0.682). Thus, 28.8 % of the patients in the case group received transfusions, versus 30.8 % of those in the control group (P = 0.830). In the second analysis, the decrease in hemoglobin concentration was 0.88 g/dl and 0.82 g/dl in case and control, respectively. CONCLUSIONS: Intravenous iron does not appear to reduce the blood transfusion requirements in the postoperative period of colorectal surgery patients with anemia. We consider that further studies are needed to more clearly define the usefulness of intravenous iron in reducing the transfusion needs in such patients.

Análisis de los problemas, relacionados con medicamentos, detectados en un hospital general / Analysis of drug-related problems detected in a general hospital

Fundamento: Desde que se prescribe un fármaco hasta que éste tiene efecto en el paciente, pueden surgir los denominados problemas relacionados con los medicamentos (PRM). En el presente trabajo se describe la metodología empleada en nuestro hospital para identificar, prevenir y resolver los PRM. El objetivo principal es valorar la prevalencia y las características de los PRM detectados y los resultados de las intervenciones realizadas. Material y métodos: Se han analizado los PRM durante un período de un año, en un hospital general de 450 camas, con sistema de distribución de medicamentos en dosis unitarias (SDMDU) en el 100% de ellas. Diariamente, el farmacéutico revisa todos los tratamientos que se han procesado en el SDMDU. Una vez identificado un paciente con un PRM, se comunica la recomendación terapéutica por escrito a través de la "Notificación farmacoterapéutica", y se registra la respuesta obtenida trascurridas 48 h. Resultados: Durante el período de estudio hubo 17.180 ingresos y se detectaron 4.859 PRM. El mayor porcentaje de PRM (54%) corresponde a medicamentos no incluidos en la Guía Farmacoterapéutica (MNIGFT); un 88% de ellos fue por fármacos susceptibles de sustitución por un medicamento incluido en la GFT. Otro grupo importante de intervenciones corresponde al grupo de las interacciones medicamentosas, recomendaciones sobre administración de medicamentos, alertas sobre alergias e indicación de monitorización farmacoterapéutica. Los fármacos mayormente implicados pertenecían al sistema cardiovascular. Las intervenciones fueron aceptadas en un 41,7%. Conclusiones: La aplicación del programa de atención farmacéutica propuesto se ha mostrado útil para detectar, prevenir y resolver PRM. De cualquier modo, dada la repercusión del problema, es necesario establecer un sistema estandarizado que permita el seguimiento del tratamiento farmacoterapéutico

Background: Drug-related problems (DRP) can arise between the time a drug is prescribed until it has an effect on the patient. The present study describes the methodology used in our hospital to identify, prevent and resolve DRP. The main objective of this study was to determine the prevalence and characteristics of the DRP detected and the results of the pharmaceutical interventions performed to resolve these events. Material and methods: DRP were analyzed during a 1-year period in a general 450-bed hospital with a unit-dose drug distribution system (UDDDS) in all beds. A pharmacist reviewed all drugs processed in the UDDDS daily. When a DRP was identified, the therapeutic recommendation was communicated in writing through standard form, and the response obtained after 48 hours was registered. Results: During the study period, there were 17180 admissions and 4859 DRP were detected. The highest percentage of DRP (54%) corresponded to drugs not included in the drug formulary and 88% of these DRP were due to drugs that could have been substituted for drugs included in the drug formulary. Another important group of pharmaceutical interventions corresponded to drug interactions, recommendations on drug administration, allergy alerts, and indications for pharmacotherapeutic monitoring. The most frequently involved drugs were those acting on the cardiovascular system. A total of 41.7% of pharmaceutical interventions were accepted. Conclusions: The application of the program proposed was useful for detecting, preventing and resolving DRP. Given the repercussions of DRP, a standardized system that would allow follow-up of drug treatment is required