Intraarticular Fibrinogen Does Not Reduce Blood Loss in TKA: A Randomized Clinical Trial

Abstract

Background Bleeding remains an ongoing concern after total knee arthroplasty (TKA). Intraarticular application of human fibrinogen with a topical thrombin has been described to stop diffuse bleeding in knee arthroplasty. Questions/purposes It was hypothesized that the use of human fibrinogen as a topical agent would result in a reduction of bleeding and transfusions required after TKA; secondary end points included comparison of early clinical results including pain scores and range of motion (ROM) at 6 weeks and complications after surgery.

Is fibrin sealant effective and safe in total knee arthroplasty? A meta-analysis of randomized trials

“…Similarly, Heyse et al [15] had shown that there was no difference between the two groups at 6 weeks follow-up. However, in the Notarnicola et al [21] study, functional recovery was quicker in patients administered the fibrin sealant.…”

Patient-Specific Instrumentation Affects Perioperative Blood Loss in Total Knee Arthroplasty

“…16,45 Moreover, when designing or evaluating studies on perioperative blood loss, we advise to take care to include data after the second postoperative day, since hidden blood loss may still occur beyond 48 hours due to hemolysis and bleeding from unresurfaced bone cut areas. 2,16,46 Hb decrease can be associated with medical short-and long-term complications and can require blood allogenic transfusion that, in addiction, may lead to an increased risk of medical complications and an important economical impact.…”

Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

“…Prior to this study, Aguilera et al arrived at a similar conclusion, favoring IV-TXA over FS (15). The efficacy of FS has been debated as some surgeons have found FS to be ineffective (14)(15)(16). Their finding could be true or it could also be due to insufficient dosage (23) or improper topical application (24).…”

“…TXA is an antifibrinolytic that binds to specific sites of both plasminogen and plasmin, competitively inhibiting the activation of plasminogen to plasmin and thus inhibiting dissolution of clots. Opinions are mixed over the true efficacy of FS in reducing perioperative blood loss and reducing the need for blood transfusion (10)(11)(12)(13)(14)(15)(16). In contrast, multiple trials have clearly demonstrated that TXA is highly reliable (17)(18)(19)(20).…”