ESAs Increase The Risk Of Death, Myocardial Infarction, Stroke, Venous Thromboembolism, Thrombosis Of Vascular Access And Tumor Progression Or Recurrence

Chronic Kidney Disease

• In controlled trials, patients with chronic kidney disease (CKD) experienced greater risks for death, serious adverse cardiovascular reactions, and stroke when administered erythropoiesis-stimulating agents (ESAs) to target a hemoglobin level of greater than 11 g/dL.
• No trial has identified a hemoglobin target level, ESA dose, or dosing strategy that does not increase these risks.
• Use the lowest ESA dose sufficient to reduce the need for red blood cell (RBC) transfusions .

Cancer

• ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in clinical studies of patients with breast, non-small cell lung, head and neck, lymphoid, and cervical cancers.
• To decrease these risks, as well as the risk of serious cardiovascular and thromboembolic reactions, use the lowest dose needed to avoid RBC transfusions.
• Use ESAs only for anemia from myelosuppressive chemotherapy.
• ESAs are not indicated for patients receiving myelosuppressive chemotherapy when the anticipated outcome is cure.
• Discontinue following the completion of a chemotherapy course.

Perisurgery

• Due to increased risk of deep venous thrombosis (DVT), DVT prophylaxis is recommended.