Comparison of Hemostatic Matrix and Standard Hemostasis in Patients Undergoing Primary TKA

Comadoll, James L; Comadoll, Shea; Hutchcraft, Audrey; Krishnan, Sangeeta; Farrell, Kelly; Kreuwel, Huub T. C.; Bechter, Mark

doi:10.3928/01477447-20120525-14

Cited by 15 publications

(17 citation statements)

References 36 publications

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“…We identified a total of 189 citations as potentially relevant. By screening the title and reading the abstract and the entire article, we found that three RCTs and two non-RCTs enrolling a total of 766 knees at a final follow-up were eligible for data extraction and meta-analysis [ 9 – 13 ]. The patients’ characteristics were presented in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

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The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

et al. 2014

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PurposeTotal knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA.MethodTwo independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows.ResultsThree RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups.ConclusionsThe present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.

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Section: Resultsmentioning

confidence: 99%

“…Most of the patients who managed to undergo primary TKA suffered from osteoarthritis. Kim and Comadoll [ 11 , 13 ] reported that all TKA were accomplished by the same doctor. Cemented prosthesis was used in four studies [ 10 – 13 ].…”

Section: Resultsmentioning

confidence: 99%

The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

et al. 2014

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“…Kim et al 18 showed no significant differences using or not the product in unilateral knee arthroplasties. However, Comadoll et al 20 showed that the use of Floseal (r) can significantly reduce the postoperative hemoglobin level drop, although it has not cause differences in the rates of blood transfusions. We analyzed preoperative data of groups of patients and there was no significant difference between the characteristics of the samples.…”

Section: Discussionmentioning

confidence: 99%

Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

et al. 2013

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Objective To evaluate whether hemostasis with eletrocauterization in comparison with Floseal(r) leads to different bleeding rates during total knee arthroplasty. Methods A comparative study was performed between two groups: group with ten consecutive total knee arthroplasties with Floseal(r) used as hemostatic method and control group with ten consecutive total knee arthroplasties with eletrocauterization as hemostatic method. Bleeding parameters such as debit of the drain, liquid infusion and blood transfusion rate were recorded. Results Floseal(r) group received less blood transfusion, less liquid infusion and lower drainage in absolute numbers compared to the control group. However, no parameter was statistically significant. Conclusion Hemostasis with Floseal(r) is as effective as hemostasis with eletrocauterization, what makes it a viable alternative to patients with contraindication to electric scalpel use. Level of Evidence II, Prospective Comparative Study.

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“…A recent retrospective chart review of 184 patients treated with FLOSEAL and 165 control subjects who underwent TKA reported that the use of FLOSEAL significantly reduced postoperative decreases in hemoglobin compared with conventional hemostatic methods, with a mean difference of 0.96 g/dL. 18 In this study, change in hemoglobin level was used as a surrogate to estimate blood loss. Blood transfusions were infrequent in both groups.…”

Section: Discussionmentioning

confidence: 98%

“…8 However, there have been few reports of its use in orthopedic surgery. [18][19][20] This study was designed to evaluate the hemostatic efficacy of the use of FLOSEAL in primary TKA, the effect of dosage (5 mL vs 10 mL), and the effect of method (timing of tourniquet release and application of FLOSEAL).…”

mentioning

confidence: 99%

Gelatin Matrix Use Reduces Postoperative Bleeding After Total Knee Arthroplasty

Velyvis¹

2015

Orthopedics

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Bleeding after total knee arthroplasty can result in significant morbidity and increases the need for blood transfusion. The proper use of intraoperative adjunctive topical hemostatic agents can enhance hemostasis perioperatively, potentially reducing blood transfusions. In this prospective study, 157 consecutive patients undergoing primary total knee arthroplasty received FLOSEAL (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, California), a gelatin thrombin hemostatic matrix, 5 mL (74 patients) or 10 mL (83 patients). All patients received warfarin as thromboprophylaxis starting the day after surgery. Data were extracted via hospital chart review from 100 consecutive patients who underwent total knee arthroplasty and immediately preceded the FLOSEAL groups and did not receive FLOSEAL (control group). Postoperative drainage was significantly lower in the FLOSEAL 5 mL (236.9 mL) and 10 mL (120.5 mL) groups compared with the control group (430.8 mL; P<.0001 for both). The FLOSEAL 10 mL group had significantly less drainage than the FLOSEAL 5 mL group (P<.0001). The predicted probability of transfusion in the FLOSEAL 5 mL group was not significantly different compared with the control group (6.0% vs 7.6%, P=.650). The predicted probability of transfusion was lower in the FLOSEAL 10 mL group compared with the control group (0.5% vs 5.5%; P=.004). Within the FLOSEAL 10 mL group, application of FLOSEAL either before or after tourniquet release had a similarly significant effect on drainage volume and predicted probability of blood transfusion. No differences in outcomes were observed by type of anesthesia used. No adverse events occurred related to FLOSEAL use.

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Comparison of Hemostatic Matrix and Standard Hemostasis in Patients Undergoing Primary TKA

Cited by 15 publications

References 36 publications

The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis

Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

Gelatin Matrix Use Reduces Postoperative Bleeding After Total Knee Arthroplasty

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