Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Abstract

Background: Total knee arthroplasty (TKA) is associated with blood loss and an increased risk of transfusion. Guidelines for antifibrinolytic drug tranexamic acid (TXA) treatment in TKA patients are available. We evaluated the effects of anticoagulant pharmacist intervention on perioperative blood conservation treatment in TKA patients. Methods: In a retrospective, observational experimental study, patients admitted for TKA were allocated into the control or pharmacist intervention group. In the intervention phase, multiple interventions of TXA treatment based on guidelines were implemented. The primary endpoint was blood loss. Other outcome included postoperative haemoglobin and haematocrit levels, allogeneic blood transfusion, cost savings and safety. Results: A total of 177 patients were included (88 and 89 in the control and intervention group, respectively). In the intervention group, 24.72% orders of TXA dosage, 20.22% orders of drug choice, 26.97% orders of TXA timing and 30.34% orders of TXA administration manner were adjusted. Eighty-nine (100%) patients received blood conservation therapy compared with 21 (23.86%) patients in the control group (P < 0.001). Total blood loss was 1133.31 ± 627.08 mL in the control group compared with 604.34 ± 459.09 mL in the intervention group (P < 0.001). Postoperative drops in haemoglobin and haematocrit in the control group were greater than in the intervention group (P < 0.001). The rate of allogeneic blood transfusion was 40.91% in the control group compared with 21.35% in the intervention group (P = 0.01). Pharmacist intervention was conducted to cost savings resulting from reduced transfusion, but with comparable safety profile. Conclusions: Anticoagulant pharmacist intervention on blood conservation treatment of TKA patients leads to favourable clinical and economic outcome.allogeneic blood transfusion, blood conservation, pharmacist intervention, tranexamic acid, venous thromboembolism Abbreviations: BMI, body mass index; DVT, deep vein thrombosis; Hb, haemoglobin; Hct, haematocrit; TKA, total knee arthroplasty; TXA, tranexamic acid; VTE, venous thromboembolism.

Perioperative clinical pharmacy practice: Responsibilities and scope within the surgical care continuum

“…Indeed, the positive clinical and economic impact of pharmacist‐managed surgical antimicrobial prophylaxis has been described previously, including significant reductions in surgical site infection, length of stay, and Medicare charges . Another retrospective observational study quantified significant reductions in blood transfusion and associated cost savings in a total knee arthroplasty (TKA) population in which pharmacist intervention on antifibrinolytic therapy was implemented . Significant improvements in postoperative complications and associated cost‐savings through pay‐for‐performance reimbursement programs were realized in another total joint arthroplasty population with the integration of a comprehensive clinical pharmacy service…”

“…28 Another retrospective observational study quantified significant reductions in blood transfusion and associated cost savings in a total knee arthroplasty (TKA) population in which pharmacist intervention on antifibrinolytic therapy was implemented. 29 Significant improvements in postoperative complications and associated cost-savings through pay-forperformance reimbursement programs were realized in another total joint arthroplasty population with the integration of a comprehensive clinical pharmacy service. 30 Strong interprofessional relationships between perioperative clinical pharmacists and the surgical team were also proven to be vital in successful stewardship efforts of high-risk or high-cost medications employed in perioperative settings.…”