Blood management in enhanced recovery after hip and knee replacement

Dao, Pierre; Massin, P.

doi:10.1016/j.otsr.2019.05.022

Cited by 21 publications

(12 citation statements)

References 33 publications

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“…Schatzker type Ⅴ and Ⅵ tibial plateau fractures are usually caused by severe crushing and collapse of the medial and lateral condyles owing to high-energy trauma; however, the internal and external double incision approach, combined with bone grafting and double steel plate fixation, can achieve ideal results 14 . As there are an abundance of blood vessels around the knee joint, an increase in the incision exposure range and the use of tourniquets can lead to a large amount of blood loss and fibrinolytic response during the perioperative period 22 . The safety and effectiveness of TXA has been proven in general surgery, joint surgery, and spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang¹,

Yupu²,

Wang³

et al. 2020

Preprint

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Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile.

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Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang¹,

Yupu²,

Wang³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Schatzker type and tibial plateau fractures are usually caused by severe crushing and collapse of the medial and lateral condyles owing to high-energy trauma; however, the internal and external double incision approach, combined with bone grafting and double steel plate xation, can achieve ideal results 14 . As there are an abundance of blood vessels around the knee joint, an increase in the incision exposure range and the use of tourniquets can lead to a large amount of blood loss and brinolytic response during the perioperative period 22 . The safety and effectiveness of TXA has been proven in general surgery, joint surgery, and spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups.The pain functional and quality of life (QoL) assessment based on their corresponding scoring system. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups.In addition, the topical group benefited in reducing postoperative pain and better QoL. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile and QoL.

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“…The inclusion criteria were as follows: (1) patients more than 18 years of age; (2) patients showing the presence of a unilateral closed tibial plateau fracture with an image inspection that conformed to Schatzker and classi cation standards; (3) patients showing no coagulopathy or abnormal hemoglobin before operation; and (4) fresh fracture, with a period between injury to hospital admission of less than 3 days. The exclusion criteria were as follows: (1) patients with severe brain, heart, liver, and kidney dysfunction, who could not tolerate surgery; (2) patients with coagulation dysfunction; (3) patients with pathological fractures or tumors; (4) patients with bilateral tibial plateau fractures or other injuries; (5) patients in whom TXA or anticoagulant drugs were contraindicated; (6) patients with incomplete data; (7) preoperative ultrasonography that shows DVT; and (8) the use of spanning external xation as a primary treatment upon patient admission. In addition, if the surgeon chose to ll the collapsed articular surface with an autologous bone graft during surgery, that patient's data were excluded from statistical analysis, as it was considered that the extra wound incision and blood loss from the iliac bone may have affected the results.…”

Section: Patientsmentioning

confidence: 99%

“…Anti brinolytic therapy, an important aspect of blood management that is considered to be closely related to the concept of enhanced recovery after surgery (ERAS), has emerged as a particular research focus 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 minutes prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P＜0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P＜0.05), 2.8 vs 3.3 (POD4, P＜0.05), and 2.1 vs. 2.6 (PO6W, P＜0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.Conclusion To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.

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Blood management in enhanced recovery after hip and knee replacement

Cited by 21 publications

References 33 publications

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of different regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

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