Cost Analysis of Tranexamic Acid in Anemic Total Joint Arthroplasty Patients

Phan, Duy L.; Ani, Fiyinfoluwa; Schwarzkopf, Ran

doi:10.1016/j.arth.2015.10.001

Cited by 18 publications

(7 citation statements)

References 24 publications

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“…The drug is universally available, safe and highly effective in correcting hyperfibrinolysis . Most importantly, TA is inexpensive and has been proven to be effective in limiting transfusion necessities and costs in the perioperative setting . It remains unknown why TA is not included in the list of therapeutic options in ITP.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of bleeding with tranexamic acid in a series of 12 patients with immune thrombocytopenia

Mayer

Salama

2017

Vox Sanguinis

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Section: Discussionmentioning

confidence: 99%

Successful treatment of bleeding with tranexamic acid in a series of 12 patients with immune thrombocytopenia

Mayer

Salama

2017

Vox Sanguinis

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“…22 It is essential that preoperative anemia is diagnosed and treated according to the algorithm of the possible treatable reasons of preoperative anemia management. 23 rhuEPO administration is indicated for patients when their Hb is > 100 g/L and < 130 g/L if undergoing elective orthopaedic surgery where high blood loss is estimated. The treatment response is independent on patient age or gender, but relies on the administered rhuEPO dosing as well as the availability of nutrients, such as iron sulfate.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement

et al. 2018

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Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was given preoperatively. Patients of Group C (n 3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly, in Group D (n 4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative and discharge hemoglobin together with total units of blood transfusion and creatinine levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82 units/patient, p < 0.001, CI 95%) in contrast to the two regimens of erythropoietin (1.16 units/patient) OrthoPAT (1.43 units/patient) and restrictive strategies (1.92 units/patient). The mean preoperative hemoglobin was 13.37 g/dL with no statistical difference among the groups of patients. The postoperative mean hemoglobin was 10.59 with no statistical difference among the groups of patients too. Additionally, the mean creatinine level was 0.93 mg/dL; however, no statistical difference among the groups of patients was noted. Finally, tranexamic acid seemed to be the most cost-effective regime. In our study, tranexamic acid proved its superiority concerning the postoperative blood transfusion on patients undergoing total knee replacement, in comparison with the other existing methods of perioperative blood management. This is a Level III, retrospective comparative study.

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“…Previous investigators have reported blood loss volumes between 1188 and 1651 ml and transfusion rates as high as 46% of cases 6 . Given these published results, anesthesiologists, and both hip and knee surgeons have typically overestimated the need for blood transfusions during and after joint replacement surgery 5,6 …”

Section: Introductionmentioning

confidence: 99%

“…3,4 Total hip and knee arthroplasty procedures that include both TKA and uni-compartmental knee arthroplasty (UKA) were traditionally associated with large amounts of blood loss and frequent blood transfusions. 5,6 Previous investigators have reported blood loss volumes between 1188 and 1651 ml and transfusion rates as high as 46% of cases. 6 Given these published results, anesthesiologists, and both hip and knee surgeons have typically overestimated the need for blood transfusions during and after joint replacement surgery.…”

Section: Introductionmentioning

confidence: 99%

“…6 Given these published results, anesthesiologists, and both hip and knee surgeons have typically overestimated the need for blood transfusions during and after joint replacement surgery. 5,6 Pre-transfusion testing that includes routine blood typing, screening, and cross-matching, when not used, wastes blood bank resources that include time, money, and manpower. 7 For this reason, several authors have emphasized the need to know how to best manage blood bank resources and organize blood-saving protocols, so that the use of pre-transfusion testing is more efficient.…”

Section: Introductionmentioning

confidence: 99%

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Is routine blood typing and screening necessary before primary total hip or knee arthroplasty in the 21st century?

et al. 2022

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Background: Blood loss warranting transfusion is a relatively rare complication of major-joint arthroplasty procedures like total knee arthroplasty (TKA) and total hip arthroplasty (THA). Despite this rarity, pre-transfusion testing (blood typing, screening, and cross-matching) has become routine. We sought to determine if such routine testing is necessary for patients who undergo a primary TKA or THA by (1) measuring the current rate of intraoperative transfusions in primary TKA and THA patients, (2) identifying risk factors for transfusions, and (3) calculating the costs of such blood typing and screening.Study Methods: We retrospectively examined the records of 992 patients who underwent primary TKA, THA, or unicompartmental knee arthroplasty (UKA) to identify patients requiring intra-operative or in-hospital postoperative transfusions. Demographic and baseline clinical and laboratory data also were collected and analyzed to identify predictors of transfusion. Cost analysis was performed.Results: The rate of intraoperative transfusion was 1.7% (17/992 patients), with rates of 2.1%, 1.6%, and 0% for TKA, THA, and UKA respectively. The inhospital transfusion rate was 10.3%, with corresponding postoperative transfusion rates of 9.1%, 12.9%, and 2%. The only baseline variable significantly linked to transfusions on multivariable analysis was preoperative hemoglobin level, with preoperative Hgb <12 g/dl predictive of transfusions in both TKA (p = .02) and THA (p = .024) patients.Discussion: Our study suggests that pre-transfusion testing for all patients undergoing primary UKA, TKA or THA is unnecessary. We recommend reserving routine pre-transfusion testing for patients with preoperative hemoglobin levels below 12 g/dl.

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Cost Analysis of Tranexamic Acid in Anemic Total Joint Arthroplasty Patients

Cited by 18 publications

References 24 publications

Successful treatment of bleeding with tranexamic acid in a series of 12 patients with immune thrombocytopenia

Successful treatment of bleeding with tranexamic acid in a series of 12 patients with immune thrombocytopenia

A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement

Is routine blood typing and screening necessary before primary total hip or knee arthroplasty in the 21st century?

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