IV iron replacement safe, effective for anemia after variceal bleed in cirrhosis patients

Patients with cirrhosis with iron deficiency anemia after variceal bleed (VB) can rely on the efficacy and safety of intravenous (IV) iron replacement, reports a study.

Eligible patients with haemoglobin <10 g/dL and iron deficiency (ferritin <100 ng/mL) after VB were included in this open-label, single-centre, randomized controlled trial. They received either IV ferric carboxymaltose (FCM; 1,500‒2,000 mg) divided into two doses (n=48) or oral carbonyl iron (100 mg elemental iron/day; n=48) for 3 months.

Change in haemoglobin at 3 months was the primary outcome, while secondary outcomes were improvement in anemia (last haemoglobin >12 g/dL), normalization of iron stores (ferritin >100 ng/mL), liver-related adverse events, adverse drug reactions, and changes in quality of life (CLDQOL questionnaire).

Both arms had similar baseline characteristics, including median Child-Turcotte-Pugh score 7 (interquartile range [IQR], 6‒9), Model for End-Stage Liver Disease score 12 (IQR, 10‒17, blood haemoglobin (8.25 g/dL), and ferritin (30.00 ng/mL).

At 3 months, the median increase in haemoglobin was 3.65 g/dL in the IV arm and 1.10 g/dL in the oral arm (p<0.001). Iron stores normalized in 84.6 percent in patients who received IV-FCM and in 21 percent of those treated with oral carbonyl iron (p<0.001). Anemia improved in 50 percent and 21.9 percent of patients in the IV and oral arms, respectively (p<0.009).

Additionally, patients in the IV arm had significant improvements in all CLDQOL domains. Liver-related adverse events were similar between the two groups, whereas transient mild/moderate hypophosphatemia occurred in 43 percent of patients on IV-FCM.