Efficacy of Intra-Articular Injection of Thrombin-Based Hemostatic Agent in the Control of Bleeding after Primary Total Knee Arthroplasty

Bae, Ki-Cheor; Cho, Chul-Hyun; Lee, Kyung-Jae; Son, Eun-Seok; Lee, Si-Wook; Lee, Suk-Joong; Lim, Kang-Won

doi:10.5792/ksrr.2014.26.4.236

Cited by 12 publications

(31 citation statements)

References 15 publications

(20 reference statements)

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“…No additional studies were obtained after the reference review. Finally, four independent RCTs 11,13,15,16 were eligible for data extraction and meta-analysis, as indicated by the flowchart in ►Fig. 1.…”

Section: Literature Searchmentioning

confidence: 99%

“…In each study, Floseal was administered intra-articularly before suturing, though the dosages varied (5-10 mL). Three studies 11,13,16 reported a transfusion trigger. Cemented prostheses were reported in three studies, 11,15,16 while the remaining study incorporated uncemented prostheses.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Three studies 11,13,16 reported a transfusion trigger. Cemented prostheses were reported in three studies, 11,15,16 while the remaining study incorporated uncemented prostheses. Prophylaxis for venous thromboembolism was achieved with various drugs in all studies; Bae et al did not state the drug name.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…All articles described the outcomes of drainage volume after TKA. 11,13,15,16 There was significant heterogeneity; therefore, a random-effect model was performed (…”

Section: Drainage Volumementioning

confidence: 99%

“…Relevant data regarding allogeneic blood transfusion were documented in three reports. 11,13,16 No significant heterogeneity was found; thus, a fixed-effect model was applied ( 2 ¼ 4.12, df ¼ 3, I 2 ¼ 27%, p ¼ 0.25; ►Fig. 5).…”

Section: Allogeneic Blood Transfusionmentioning

confidence: 99%

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Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty

Tian

et al. 2016

J Knee Surg

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The present meta-analysis pooled the results from randomized controlled trials (RCTs) to identify and assess the efficacy and safety of thrombin-based hemostatic agent in primary total knee arthroplasty (TKA). Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5), and ScienceDirect (1966-2015.5). Relevant journals and the recommendations of expert panels were also searched by using Google search engine. RCTs assessing the efficacy and safety of thrombin-based hemostatic agent in primary TKA were included. Pooling of data was analyzed by RevMan 5.1 (The Cochrane Collaboration, Oxford, UK). A total of four RCTs met the inclusion criteria. The meta-analysis revealed significant differences in postoperative hemoglobin decline ( < 0.00001), total blood loss ( < 0.00001), drainage volume ( = 0.01), and allogenic blood transfusion ( = 0.01) between the treatment group and the control group. No significant differences were found regarding incidence of infection ( = 0.45) and deep vein thrombosis (DVT; = 0.80) between the groups. Meta-analysis indicated that the application of thrombin-based hemostatic agent before wound closure decreased postoperative hemoglobin decline, drainage volume, total blood loss, and transfusion rate and did not increase the risk of infection, DVT, or other complications. Therefore, the reviewers believe that thrombin-based hemostatic agent is effective and safe in primary TKA.

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Section: Literature Searchmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

“…All articles described the outcomes of drainage volume after TKA. 11,13,15,16 There was significant heterogeneity; therefore, a random-effect model was performed (…”

Section: Drainage Volumementioning

confidence: 99%

Section: Allogeneic Blood Transfusionmentioning

confidence: 99%

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Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty

Tian

et al. 2016

J Knee Surg

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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