Effects of hypotensive anesthesia, nonsteroidal antiinflammatory drugs, and polymethylmethacrylate on bleeding in total hip arthroplasty patients

An, Howard S.; Mikhail, W. E. M.; Jackson, William T.; Tolin, Brad S.; Dodd, George A.

doi:10.1016/s0883-5403(06)80171-3

Cited by 41 publications

(18 citation statements)

References 18 publications

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“…Our results are consistent with those found in the literature [1,11]. Like these authors, we found no correlation between weight, age, duration of the surgical procedure and blood loss; we observed, however, a generally greater blood loss in men.…”

Section: Discussionsupporting

confidence: 93%

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

Charrois

Kahwaji

Vastel

et al. 2001

International Orthopaedics (SICOT)

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We studied the perioperative blood loss in 100 total hip arthroplasties performed for rapidly destructive coxarthrosis and compared it with the blood loss in 100 total hip arthroplasties for regular coxarthrosis. The treatment protocol was identical in both groups. Total blood loss was calculated as the compensated blood loss (volume transfused during and immediately after surgery) and the non-compensated blood loss using Nadler and Mercuriali formula. The mean blood loss calculated in milliliters of red blood cells (100% haematocrit) was 578 ml in regular coxarthrosis and 945 ml in rapidly destructive coxarthrosis. The blood loss after total hip arthroplasty is greater when surgery is performed for rapidly destructive coxarthrosis than for regular coxarthrosis (P<0.001).Résumé Nous avons étudié la perte sanguine dans 100 arthroplasties totales de hanche exécutées pour coxarthrose destructrice rapide et l'avons comparé avec la perte sanguine dans 100 arthroplasties pour coxarthrose habituelle. Le protocole du traitement était identique dans les deux groupes. La perte sanguine totale a été calculée comme la perte sanguine compensée (le volume à transfuser pendant et immédiatement après chirurgie) et la perte sanguine non -compensée en utilisant la formule de Nadler et Mercuriali. La perte moyenne, calculé en ml de cellules de sang rouge (100% d'hématocrite) était de 578 ml dans la coxarthrose habituelle et de 945 ml dans la coxarthrose destructrice rapide. La perte sanguine après arthroplastie de hanche est plus importante quand la chirurgie est exécutée pour coxarthrose destructrice rapide que pour coxarthrose habituelle (P<0.001).

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Section: Discussionsupporting

confidence: 93%

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

Charrois

Kahwaji

Vastel

et al. 2001

International Orthopaedics (SICOT)

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“…Differences in surgical techniques, however, were not taken into account in the present study. Three studies have reported that the use of a cemented prothesis significantly reduces blood loss in THR and TKR [13, 16, 17], whereas a recently published large study failed to show any significant association between a cemented hip prothesis and reduced need for allogeneic red cell transfusions [6]. Thus, the data concerning fixation of the protheses might have affected our results.…”

Section: Discussionmentioning

confidence: 90%

Transfusion Practices in Primary Total Joint Replacements in Finland

Capraro

1998

Vox Sanguinis

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Background and Objectives: A multicenter survey was carried out in 11 Finnish hospitals to determine the prevailing transfusion practices in orthopedic surgery. Materials and Methods: The records of 1,161 patients who had undergone primary total hip (THR) or knee replacement (TKR) were reviewed. Results: Allogeneic red cells (RBC) were administered to 92% of the THR patients and to 84% of the patients undergoing TKR. Significant interhospital variation in RBC transfusion, from 2.4 to 4.1 units per patient in THR and from 1.8 to 2.8 units in TKR, was detected after adjustment for clinical and laboratory findings. Conclusion: The use of RBCs in orthopedic surgery was generous compared with reports from other European countries and the US. Each hospital’s individual transfusion policy seemed to be a strong determinant of allogeneic blood use.

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“…While others reported that patients who use APA tend to have lower initial hemoglobin concentrations,[13] our study shows that the admission hemoglobin concentrations did not differ between the APA and non-APA groups [Table 2]. Some authors note increased perioperative blood loss in patients taking APA before orthopedic procedures,[926] while others have reported no effect. [513] In this study, there were no statistical differences in terms of operative blood loss or blood transfusions between APA and non-APA groups.…”

Section: Discussionmentioning

confidence: 49%

The impact of antiplatelet therapy on pelvic fracture outcomes

Christy

Stawicki

Jarvis

et al. 2011

J Emerg Trauma Shock

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Introduction:Despite increasing use of antiplatelet agents (APA), little is known regarding the effect of these agents on the orthopedic trauma patient. This study reviews clinical outcomes of patients with pelvic fractures (Pfx) who were using pre-injury APA. Specifically, we focused on the influence of APA on postinjury bleeding, transfusions, and outcomes after Pfx.Methods:Patients with Pfx admitted during a 37-month period beginning January 2006 were divided into APA and non-APA groups. Pelvic injuries were graded using pelvic fracture severity score (PFSS)–a combination of Young–Burgess (pelvic ring), Letournel–Judet (acetabular), and Denis (sacral fracture) classifications. Other clinical data included demographics, co-morbid conditions, medications, injury severity score (ISS), associated injuries, morbidity/mortality, hemoglobin trends, blood product use, imaging studies, procedures, and resource utilization. Multivariate analyses for predictors of early/late transfusions, pelvic surgery, and mortality were performed.Results:A total of 109 patients >45 years with Pfx were identified, with 37 using preinjury APA (29 on aspirin [ASA], 8 on clopidogrel, 5 on high-dose/scheduled non-steroidal anti-inflammatory agents [NSAID], and 8 using >1 APAs). Patients in the APA groups were older than patients in the non-APA group (70 vs. 63 years, P < 0.01). The two groups were similar in gender distribution, PFSS and ISS. Patients in the APA group had more comorbidities, lower hemoglobin levels at 24 h, and received more packed red blood cell (PRBC) transfusions during the first 24 h of hospitalization (all, P < 0.05). There were no differences in platelet or late (>24 h) PRBC transfusions, blood loss/transfusions during pelvic surgery, lengths of stay, post-ED/discharge disposition, or mortality. In multivariate analysis, predictors of early PRBC transfusion included higher ISS/PFSS, pre-injury ASA use, and lower admission hemoglobin (all, P < 0.03). Predictors of late PRBC transfusion included the number of complications, gender, PFSS, and any APA use (all, P < 0.05). Mortality was associated with pelvic hematoma/contrast extravasation on imaging, number of complications, and higher PFSS/ISS (all, P < 0.04).Conclusions:Results of this study support the contention that preinjury use of APA does not independently affect morbidity or mortality in trauma patients with Pfx. Despite no clinically significant difference in early postinjury blood loss, pre-injury use of APA was associated with increased likelihood of receiving PRBC transfusion within 24 h of admission. Furthermore, multivariate analyses demonstrated that among different APA, only preinjury ASA (vs. clopidogrel or NSAID) was associated with early PRBC transfusions. Late transfusion was associated with the use of any APA, complications, higher PFSS, and need for pelvic surgery.

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Effects of hypotensive anesthesia, nonsteroidal antiinflammatory drugs, and polymethylmethacrylate on bleeding in total hip arthroplasty patients

Cited by 41 publications

References 18 publications

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

Blood loss in total hip arthroplasty for rapidly destructive coxarthrosis

Transfusion Practices in Primary Total Joint Replacements in Finland

The impact of antiplatelet therapy on pelvic fracture outcomes

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