Abstract
References
- Berman AT, Geissele AE, Bosacco SJ. Blood loss with total knee arthroplasty. Clin Orthop Relat Res 1988; 234: 137-8.
- Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 2000; 7: 151-5.
- Barr PJ, Donnelly M, Cardwell C, et al. Drivers of transfusion decision making and quality of the evidence in orthopedic surgery: a systematic review of the literature. Transfus Med Rev 2011; 25: 304-16.
- Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol 2007; 21: 271-89.
- Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br 2008; 90: 1128-36.
- Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 2010; 18: 132-8.
- Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999; 57: 1005-32.
- Naoulou B, Tsai MC. Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand 2012; 91: 529-37.
- Melvin JS, Stryker LS, Sierra RJ. Tranexamic acid in hip and knee arthroplasty. J Am Acad Orthop Surg 2015; 23: 732-40.
- Chen JY, Chin PL, Moo IH, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial. Knee 2016; 23: 152-6.
- Goyal N, Chen DB, Harris IA, Rowden NJ, Kirsh G, MacDessi SJ. Intravenous vs intra-articular tranexamic acid in total knee arthroplasty: a randomized, double-blind trial. J Arthroplasty 2017; 32: 28-32.
- Mi B, Liu G, Zhou W, et al. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2017; 137: 997-1009.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Italian Society of Transfusion Medicine and Immunohaematology Working Party. Recommendations for the transfusion management of patients in the peri-operative period. III. The post-operative period. Blood Transfus 2011; 9: 320-35.
- Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012; 94: 1153-9.
- Tzatzairis T, Drosos GI, Vogiatzaki T, Tilkeridis K, Ververidis A, Kazakos K. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg 2019; 139: 859-68.
- Wang D, Wang HY, Luo ZY, Pei FX, Zhou ZK, Zeng WN. Finding the optimal regimen for oral tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2019; 101: 438-45.
- Schnettler T, Papillon N, Rees H. Use of a Tourniquet in total knee arthroplasty causes a paradoxical ıncrease in total blood loss. J Bone Joint Surg Am 2017; 99: 1331-6.
- Saad BN, Menken LG, Elkattaway S, Liporace FA, Yoon RS. Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty. Patient Saf Surg 2021; 15: 21.
- Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344: e3054.
- Dechartres A, Boutron I, Trinquart L, Charles P, Ravaud P. Single-center trials show larger treatment effects than multicenter trials: evidence from a meta-epidemiologic study. Ann Intern Med 2011; 155: 39-51.
Tranexamic acid in knee arthroplasty: the effect of preoperative intravenous administration of together with postoperative intravenous maintenance and periarticular administration on bleeding, transfusion, and hospitalization time – a retrospective cohort study
Abstract
Objective: To compare patients who received preoperative intravenous (IV) plus postoperative maintenance IV tranexamic acid (TXA) therapy and perioperative periarticular TXA to those who did not receive TXA during total knee arthroplasty (TKA) in terms of blood loss, transfusion requirements, and length of hospital stay.
Material and Method: Data from 194 patients who underwent TKA between 2016 and 2019 were reviewed. A total of 106 patients were included. Twenty-one patients were male, and 95 were female. The patients were divided into three groups: Group 1 (n=37) that did not receive perioperative TXA, Group 2 (n=35) that received preoperative IV and postoperative maintenance TXA therapy, and Group 3 (n=34) that received preoperative IV and perioperative periarticular TXA. The groups were similar regarding demographic data. Statistical comparisons between the groups were made concerning the decrease in hemoglobin levels on postoperative days 1 and 3, the need for transfusion, and the length of hospital stay.
Results: The mean decrease in hemoglobin on the postoperative first and third days were 1.69(±1.13) and 2.94(±1.14)g/dl, in Group 1, 1.41(±0.99) and 2.44(±1.28)g/dl, in Group 2, and 1.24(±0.83) and 2.21(±0.84)g/dl in Group 3 respectively. The statistical comparison of the hemoglobin decrease revealed a significant difference between Groups 1 and 3 on the postoperative first day(p<0.05). There was no other significant difference between the remaining group pairs. There was a statistically significant difference in the length of hospital stay and the amount of erythrocyte suspension used between Groups 1 and other groups (p<0.05). In Group 1, prolonged wound discharge was observed in four patients. No additional surgical intervention was performed in any of the three groups due to infection, and no vascular thrombosis or embolism was observed.
Conclusion: Our results showed that IV and periarticular TXA applications in TKA effectively reduced bleeding and bleeding-related complications without causing additional complications.
Keywords
References
- Berman AT, Geissele AE, Bosacco SJ. Blood loss with total knee arthroplasty. Clin Orthop Relat Res 1988; 234: 137-8.
- Sehat KR, Evans R, Newman JH. How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 2000; 7: 151-5.
- Barr PJ, Donnelly M, Cardwell C, et al. Drivers of transfusion decision making and quality of the evidence in orthopedic surgery: a systematic review of the literature. Transfus Med Rev 2011; 25: 304-16.
- Shander A, Hofmann A, Gombotz H, Theusinger OM, Spahn DR. Estimating the cost of blood: past, present, and future directions. Best Pract Res Clin Anaesthesiol 2007; 21: 271-89.
- Lemaire R. Strategies for blood management in orthopaedic and trauma surgery. J Bone Joint Surg Br 2008; 90: 1128-36.
- Eubanks JD. Antifibrinolytics in major orthopaedic surgery. J Am Acad Orthop Surg 2010; 18: 132-8.
- Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs. 1999; 57: 1005-32.
- Naoulou B, Tsai MC. Efficacy of tranexamic acid in the treatment of idiopathic and non-functional heavy menstrual bleeding: a systematic review. Acta Obstet Gynecol Scand 2012; 91: 529-37.
- Melvin JS, Stryker LS, Sierra RJ. Tranexamic acid in hip and knee arthroplasty. J Am Acad Orthop Surg 2015; 23: 732-40.
- Chen JY, Chin PL, Moo IH, et al. Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: a double-blinded randomised controlled noninferiority trial. Knee 2016; 23: 152-6.
- Goyal N, Chen DB, Harris IA, Rowden NJ, Kirsh G, MacDessi SJ. Intravenous vs intra-articular tranexamic acid in total knee arthroplasty: a randomized, double-blind trial. J Arthroplasty 2017; 32: 28-32.
- Mi B, Liu G, Zhou W, et al. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2017; 137: 997-1009.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G. Italian Society of Transfusion Medicine and Immunohaematology Working Party. Recommendations for the transfusion management of patients in the peri-operative period. III. The post-operative period. Blood Transfus 2011; 9: 320-35.
- Yang ZG, Chen WP, Wu LD. Effectiveness and safety of tranexamic acid in reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012; 94: 1153-9.
- Tzatzairis T, Drosos GI, Vogiatzaki T, Tilkeridis K, Ververidis A, Kazakos K. Multiple intravenous tranexamic acid doses in total knee arthroplasty without tourniquet: a randomized controlled study. Arch Orthop Trauma Surg 2019; 139: 859-68.
- Wang D, Wang HY, Luo ZY, Pei FX, Zhou ZK, Zeng WN. Finding the optimal regimen for oral tranexamic acid administration in primary total hip arthroplasty: a randomized controlled trial. J Bone Joint Surg Am 2019; 101: 438-45.
- Schnettler T, Papillon N, Rees H. Use of a Tourniquet in total knee arthroplasty causes a paradoxical ıncrease in total blood loss. J Bone Joint Surg Am 2017; 99: 1331-6.
- Saad BN, Menken LG, Elkattaway S, Liporace FA, Yoon RS. Tranexamic acid lowers transfusion requirements and hospital length of stay following revision total hip or knee arthroplasty. Patient Saf Surg 2021; 15: 21.
- Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012; 344: e3054.
- Dechartres A, Boutron I, Trinquart L, Charles P, Ravaud P. Single-center trials show larger treatment effects than multicenter trials: evidence from a meta-epidemiologic study. Ann Intern Med 2011; 155: 39-51.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Original Article |
| Authors | |
| Publication Date | March 15, 2022 |
| Published in Issue | Year 2022 Volume: 5 Issue: 2 |
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