Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. Methods. In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). Results. Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). Conclusion. The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.
Aim. To determine the most effective administration of tranexamic acid (TXA) in patients with primary total knee arthroplasty (TKA). Material and Method. We enrolled a total of 400 patients (154 men and 346 women) in this randomized trial (4 groups, each of 100 patients). The first group (IV1) had a single intravenous dose (15 mg TXA/kg) prior to skin incision. Group 2 (IV2) had TXA in 2 intravenous doses (15 mg TXA/kg): prior to skin incision and 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 mL of saline irrigated topically at the end of the surgery. The fourth group (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Results. The amount of TBL was significantly lower in IV1, IV2 and COMB regimens compared to the TOP (P<0.0001). The lowest decrease in haemoglobin within 12 hours after surgery was observed in intravenous regimens (P=0.045). A significant difference in haemoglobin decrease on day 1 after the surgery was demonstrated in the COMB and intravenous regimens (P=0.011). Conclusion. In primary TKA, it is preferable to administer TXA intravenously in two doses or in a combined regimen. Simple topical administration of TXA was not as effective and is indicated only in cases where systemic administration of TXA is contraindicated. No substantial complications occurred in either group of patients.
PURPOSE OF THE STUDYTo determine the optimal strategy for tranexamic acid (TXA) administration in diabetic patients, smokers and obese patients (BMI > 30 kg/m 2 ) undergoing primary total knee arthroplasty (TKA). MATERIAL AND METHODSThe total of 400 consecutive patients indicated for primary TKA were randomised into 4 basic groups with different TXA administration regimens. Group 1 (IV1) had a single intravenous dose (15 mg TXA/kg) applied prior to skin incision. Group 2 (IV2) got two intravenous doses (15 mg TXA/kg): one prior to skin incision and one subsequently 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 ml of saline irrigated topically at the end of the surgery. Group 4 (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Follow-up period was one year postoperatively. RESULTSIn the group of diabetic patients (n = 87; 21.7%) the lowest TBL was observed in the order: IV1, IV2 > COMB > TOP. In the obese patients (BMI > 30 kg/m 2 ; n = 242; 60.5%), TBL was significantly lower in the intravenous regimens (IV1: p = 0.002; IV2: p = 0.005, respectively) than in the TOP regimen. In the smoking patients (n = 30; 7.5%), TBLs were significantly lower in the order: IV1 > IV2 > COMB > TOP. DISCUSSIONIndividualised approach to prevention and therapy is a recent trend, also because comorbidities significantly affect the result of the intervention. In the case of diabetes, obesity and smoking, there is a proven link to early post-operative infections, mainly due to poorer innate immunity. It is conceivable, though, that the occurrence of infectious complications is also contributed to by larger hematomas or hemarthroses which are largely preventable. CONCLUSIONSIn the diabetic and obese patients (BMI > 30 kg/m 2 ), the combined topical/intravenous TXA application and two intravenous doses of TXA interventions were shown to be the most effective. However, no evidence of superiority of any of the TXA administration routes was obtained in the smokers. None of the TXA protocols was associated with a higher incidence of complications or early reoperation following TKA surgery.
PURPOSE OF THE STUDYThis study aims to describe and analyze the age differences in the 24-hour movement behavior patterns among a sample of adults and older adults with end-stage knee osteoarthritis referred for total knee arthroplasty (TKA). MATERIAL AND METHODSA total of 86 patients referred for TKA were included in this study. Sleep duration, sedentary behavior (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) were assessed using multi-day 24-hour raw data from wrist-worn accelerometers. Compositional data analysis was used to analyze the differences between the age categories. RESULTSOn average (SD), the adults were 59.0 (± 4.9) years; 63% female. The older adults were 72.4 (± 5.5) years; 58% female. The adults reached 23.9 milli-gravitational units (mg) as a mean acceleration over the whole day; 34% (8.1 h/day) of the time was classified as sleep, 48.9% (11.7 h/day) as SB, 12.1% (2.9 h/day) as LPA, and 5.1% (72.9 min/day) as MVPA. The older adults reached 21.3 mg; 35.2% (8.4 h/day) of the time was classified as sleep, 50.4% (12.1 h/day) as SB, 11.3% (2.7 h/day) as LPA, and 3.1% (44.9 min/day) as MVPA. Compared with the older adults, the proportion of time spent in total MVPA (P = 0.008) and MVPA bouts of ≥1 min were greater (P ≤ 0.028) in the adult group, while the proportion of time spent in total SB was lower (P = 0.045). No age difference was found for the proportion of time spent asleep. DISCUSSIONSleep, SB, and PA are exclusive and exhaustive parts of the overall 24-h day. Using accelerometer-based measures of 24-hour movement behavior to describe these behaviors more accurately is crucial for a better understanding of patients with end-stage KOA. CONCLUSIONSOur findings suggest that the adults and older adults referred for TKA are physically active despite suffering from severe knee osteoarthritis. Such a high level of physical activity may be difficult to increase by TKA postoperatively. If replicated by other studies, 24-hour movement behaviors should be implemented among the examinations required before TKA.
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