Patient blood management strategies in total hip and knee arthroplasty

Abstract

Background: Patient blood management in total hip and knee arthroplasty involves a three-pillar approach of optimizing red blood cell mass, minimizing blood loss, and managing anemia. We describe the effect of implementation of various strategies over a 7-year period. Methods: We prospectively collected blood transfusion data over a yearly quarter in the years of 2009, 2012, 2014, and 2015 with patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA), primary and revision procedures. Evidence-based patient blood management strategies were introduced, including a tranexamic acid (TXA) protocol. The data were retrospectively analyzed, with observations of rates and appropriateness of blood transfusions in the context of changes in Australian National Blood Authority guidelines. Results: There was a significant reduction in transfusion rates from 2009 to 2015 in both THA (38.5%, 24.4%, 8.5%, and 12.5% for 2009, 2012, 2014, and 2015, χ2=17.9, P<0.05), and TKA (12.4%, 6.1%, 7.8%, and 2.1% for 2009, 2012, 2014, and 2015, χ2=4.2, P<0.05). This coincided with an increased adherence to national blood management guidelines in both THA and TKA (χ2=7.19, P=0.027). Conclusions: Patient blood management is multifaceted, and significant reductions in transfusion can be achieved in adherence to perioperative patient blood management guidelines. Tranexamic acid also is an important contributor in the improvement of transfusion rates in THA and TKA.

Intravenous versus Intra-Articular Tranexamic Acid in Primary Total Hip Arthroplasty: A Prospective Randomised Double Blinded Non-Inferiority Trial

“…Hasan, A 1 ; Campbell, D 1,2 ; Lewis, P 1,2 Abstact Background: Tranexamic acid (TXA) has been shown to be effective in reducing post-operative blood loss after hip replacement surgery. Clinicians can be reluctant to administer intravenous (IV) TXA to high risk patients and intra-articular (IA) administration has been proposed as an alternative mode of delivery.…”

“…Tranexamic acid (TXA), an antifibrinolytic agent that has been in clinical use since the 1960s, has become commonly used in orthopaedic surgery over the last decade, often as a component of a multimodal blood loss management strategy. Post operative anaemia is common following hip arthroplasty surgery with some studies reporting transfusion rates of 24.4% prior to the introduction of TXA [1]. Allogeneic transfusions are associated with complications including immunosuppression, perioperative infections and transfusion-related reactions [2,3].…”

Patient blood management in orthopedic surgery

“…Распространенной рекомендацией является предоперационная однократная внутривенная инъекция транексамовой кислоты в дозе 10-15 мг на 1 кг массы тела [24,34]. Существуют и более сложные протоколы дозирования транек-самовой кислоты, включающие повторные инъекции препарата с интервалом 8 ч и коррекцией дозы в зависимости от скорости клубочковой фильтрации [35].…”

Preoperative blood transfusion associated with increased length of stay and increased postoperative complications after revision total knee arthroplasty

“…Perioperative anemia exists in up to 80% of patients undergoing major orthopedic procedures, 3 and various strategies exist in current practice regarding peri-operative blood management. Pre-operative blood management strategies include supplementation with iron or Procrit, as well as the management of anti-platelet agents.…”

“…Pre-operative blood management strategies include supplementation with iron or Procrit, as well as the management of anti-platelet agents. 4 Intra-operative use of TXA has been shown to be successful in mitigating blood loss in several surgical disciplines, 3 though other strategies include the use of tourniquets to reduce blood flow to lower extremities, hypotensive epidural anesthesia, acute normovolemic hemodilution, antifibrinolytic agents, topical fibrin sealants, intraoperative cell salvage, epinephrine containing injections, platelet-rich plasma injections, and sealing the femoral tunnel. 4 As much as 50% of total blood loss in TKA occurs post-operatively, so post-operative strategies include joint compression, cryotherapy, post-operative cell saving, and drain clamping.…”