Sucrosomial Vs Intravenous Iron for Preoperative Anemia

Participants will be randomly assigned in a 1 to 1 ratio to one of two treatment groups. One group will receive intravenous (IV) iron, and the other group will receive oral sucrosomial iron.

Participants assigned to the IV iron group will receive two infusions at the University of Rochester Medical Center Center for Perioperative Medicine. Intravenous iron will be administered through a small plastic tube placed into a vein. Saline may be used to maintain the IV line as needed.

Participants assigned to the oral sucrosomial iron group will receive capsules to take at home until the date of surgery, with a dosage of two capsules per day.

All other aspects of perioperative care will follow standard practice. A blood sample for complete blood count and iron studies will be obtained on the day of surgery. This is typically collected when the IV is placed, so an additional needle stick is usually not required.

Randomization applies only to the two treatment arms (intravenous iron and oral sucrosomial iron). The third arm is a non randomized observational cohort for data collection only.

Inclusion criteria

• Age ≥18 years
• Scheduled for elective cardiac surgical procedures, including:
• Coronary artery bypass graft surgery (CABG)
• Valve procedures
• Aortic root procedures
• Transcatheter aortic valve implantation (TAVI)
• Hemoglobin <12 g/dL and ≥10 g/dL on a complete blood count obtained at the Center for Perioperative Medicine pre operative visit
• Evidence of iron deficiency
• Able to provide informed consent
• Able to understand spoken and written English

Exclusion criteria

• Scheduled for cardiac surgery requiring deep hypothermia or circulatory arrest
• Undergoing heart transplantation or ventricular assist device placement
• Lacking capacity to provide informed consent or unable to understand spoken and written English
• Baseline hemoglobin >12 g/dL or <10 g/dL
• Use of anticoagulant medications within 5 days of the Center for Perioperative Medicine visit, or planned initiation of anticoagulant therapy before surgery
• History of hemoglobinopathy
• History of hematologic malignancy
• Bone marrow suppression from non nutritional causes
• Vitamin B12 or folate deficiency
• Known liver disease
• Known kidney disease
• Normal serum iron studies at baseline