USMLE

Epoetin Alfa

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Hematology Drugs
  1. Dabigatran / Argatroban
  2. Factor Xa Inhibitors (Rivaroxaban, Apixaban)
  3. Heparin
  4. Low Molecular Weight Heparins (Enoxaparin, Fondaparinux, Dalteparin)
  5. Warfarin
  6. Aspirin
  7. GPIIb/IIIa Inhibitors (Abciximab, Tirofiban, Eptifibatide)
  8. Alteplase / tPA
  9. Iron
  10. Filgrastim
  11. Epoetin Alfa

Summary

Epoetin alfa, or just epoetin for short, is a drug that is basically a synthetic form of the naturally-occurring hormone, erythropoietin. Epoetin is given to patients with anemia to stimulate the production of red blood cells and to increase hemoglobin levels. By increasing the number of red blood cells, Epoetin increases the thickness or viscosity of blood, which explains it’s main side effect: an increased chance of developing blood clots. As such, the drug is contraindicated in patients with a high risk or history of blood clots. To prevent blood clots from occurring, the hemoglobin should be closely monitored and should not rise above 11 grams per deciliter.

Key Points

  • Mechanism
    • Synthetic (recombinant) Erythropoietin (EPO)
      • Erythropoietin is a naturally occurring hormone from the kidneys that increases red blood cells by stimulating the bone marrow
    • Clinical Use
      • Anemia
        • Target goal is to increase the hemoglobin to the lowest possible level that does not require a blood transfusion
        • Especially useful in chronic kidney disease, where the kidneys are not producing erythropoietin, and in cancer patients where the chemotherapy is suppressing the bone marrow’s production of RBC
        • May be offered to people who refuse blood products (e.g. Jehovah’s Witness)
    • Side Effects and Adverse Reactions
      • Thrombotic Events
        • Myocardial infarction, stroke, pulmonary embolism, etc.
        • Hemoglobin should not exceed 11 g/dL
          • Black box warning
          • Hemoglobin and hematocrit will be monitored periodically during treatment
        • Monitor patient for signs of chest pain, shortness of breath, and altered mental status
        • Contraindicated in hypertension or patients with a history of heart attack or stroke, as they are at an increased risk of blood clots