General Assembly, Prevention, Blood Conservation: Proceedings of International Consensus on Orthopedic Infections

Objectives This study aims to investigate if the use of intravenous (IV) tranexamic acid (TXA) during one-stage exchange for periprosthetic joint infection (PJI) of the hip that necessitates an extensive debridement is associated with decreased blood loss, if the rate of blood transfusion that may lead to side effects can be lowered with IV TXA, and if there is any difference regarding the occurrence of postoperative venous thromboembolism (VTE). Patients and methods We retrospectively reviewed patients who underwent one-stage exchange for PJI of the hip with perioperative IV administration of TXA (n=163; 90 males, 73 females; mean age 68±10.3; range, 25 to 90 years) between January 2015 and December 2016 and compared them to another group (n=190; 106 males, 84 females; mean age 71±10.1; range, 39 to 92 years) who underwent one-stage exchange for PJI of the hip without perioperative IV administration of TXA between January 2006 and December 2012. Blood loss, transfusion rates, amount of transfused blood, and occurrence of VTE complications were observed. Results Mean blood loss of the TXA group was significantly lower than that of the non-TXA group (2.4 L and 4.5 L, respectively; p<0.001). Patients in non-TXA group experienced significantly higher rate of blood transfusion (71.1% and 58.3%, respectively; p=0.014) and higher quantity of transfused packed red blood cells (3.2 and 1.9 units, respectively; p<0.001). There was one patient with VTE complication in each group. Conclusion Even in the presence of infection, usage of IV TXA during one-stage exchange for PJI of the hip is associated with significantly lower blood loss and transfusion rates showing no higher risk of VTE events.

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“…Furthermore, patients receiving allogeneic blood transfusion are at increased risk of PJI. [ 23 , 24 ]…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients receiving allogeneic blood transfusion are at increased risk of PJI. [23,24] Recently, few studies have addressed the effect of TXA on infection rates; however, with controversial results. [25][26][27] Tranexamic acid was associated with reduced postsurgical infection rate following cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Intravenous tranexamic acid is associated with safe reduced blood loss and transfusion rate in one-stage exchange for infected hip arthroplasty

et al. 2021

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“…The CDC concluded that there are uncertain tradeoffs between the benefits and harms of transfusion and highlighted that transfusion of necessary blood products should not be withheld from patients as a means to prevent SSI [21]. The ICM also highlighted an increased risk of SSI and PJI with allogeneic blood transfusion and recommended implementing intraoperative strategies such as meticulous hemostasis, use of tourniquet, and administration of topical or intravenous tranexamic acid to reduce blood loss and the need for transfusion [113].…”

Section: Blood Transfusionmentioning

confidence: 99%

Intraoperative and Postoperative Infection Prevention

Goswami

Stevenson

Parvızı

2020

The Journal of Arthroplasty

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“…To date, however, no comprehensive literature or consensus recommendations are available addressing this approach [ 20 ]. The following questions arise:…”

Section: Introductionmentioning

confidence: 99%

The Use of Intraoperative Cell Salvage in Two-Stage Revision of Septic Hip Arthroplasties: A Double-Center Retrospective Study

et al. 2023

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(1) Background: intraoperative cell salvage (ICS) devices can provide a valuable contribution to patient blood management. An infection of the surgical site presents a formal contraindication to the use of ICS. To date, there is no recommendation for the use of ICS in the context of reimplantation in two-stage septic exchange arthroplasty. (2) Methods: at two hospitals of maximum endoprosthetic care, a retrospective evaluation of patients who had received ICS blood during reimplantation of hip arthroplasties was performed. Patients’ and surgical characteristics, intraoperative cultures, and the occurrence of septic complications in the short- and long-term follow-up were recorded. (3) Results: 144 patients were included. Detection of positive cultures during reimplantation occurred in 13 cases. A total of 127 patients showed no complication, 8 patients showed a non-specific septic complication, 6 patients a local persistence of infection, and 3 patients a possible bloodstream-associated infection. No significant correlation was found between the occurrence of complications and the detection of positive intraoperative cultures. (4) Conclusions: no clustering of septic complications due to the use of ICS during reimplantation was found. In the risk-benefit analysis, we considered the use of ICS during reimplantation to be indicated in terms of patient blood management, while the safety of the procedure during septic first-stage resection arthroplasty or septic one-stage exchange arthroplasty was not investigated. Given the paucity of comparative literature, further studies are needed on ideal patient blood management in the setting of septic revision arthroplasty.

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General Assembly, Prevention, Blood Conservation: Proceedings of International Consensus on Orthopedic Infections

Cited by 11 publications

References 92 publications

Intravenous tranexamic acid is associated with safe reduced blood loss and transfusion rate in one-stage exchange for infected hip arthroplasty

Intravenous tranexamic acid is associated with safe reduced blood loss and transfusion rate in one-stage exchange for infected hip arthroplasty

Intraoperative and Postoperative Infection Prevention

The Use of Intraoperative Cell Salvage in Two-Stage Revision of Septic Hip Arthroplasties: A Double-Center Retrospective Study

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