Treating iron deficiency anemia (IDA) with intravenous iron therapy may reduce blood coagulability, resulting in changes in thrombin generation and factor VIII activity levels, according to a study published in the British Journal of Haematology.

There is a well-established association between IDA and thrombotic events, but little is known about the mechanisms involved. In this study, researchers examined the changes in coagulability in 48 patients with IDA who were receiving iron replacement therapy. The mean age at enrollment was 47.0 years and 45 of the 48 patients were women. The researchers defined IDA as a hemoglobin concentration lower than 130 g/L in men and lower than 120 g/L in women, along with a ferritin level lower than 15 µg/L.

Coagulability was assessed by quantifying thrombin generation using a calibrated automated thrombogram. Changes in factor VIII activity were also measured.

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Endogenous thrombin potential decreased by an average of 122.4 nmol/L/min (P =.023). Peak height decreased by an average of 51.9 nmol/L (P <.001), and peak time increased by an average of 23.6 seconds (P =.012). Lag time did not significantly change after intervention (P =.777), but the statistically significant change towards lower coagulability in 3 of 4 parameters allowed the researchers to conclude that treating patients with IDA using intravenous iron replacement therapy reduced the coagulability of their blood.

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The researchers noted further studies are needed to investigate whether receiving aggressive iron replacement therapy such as intravenous iron compared with a more lenient therapy such as oral iron would influence thromboembolism incidence. Furthermore, assessment of clinical outcomes for venous and arterial thrombosis in patients with IDA treated with iron replacement therapy is warranted.


  1. Nashashibi J, Avraham GR, Schwartz N, et al. Intravenous iron treatment reduces coagulability in patients with iron deficiency anaemia: a longitudinal study [published online January 25, 2019]. Br J Haematol. doi: 10.1111/bjh.15765