Reduction of Perioperative Blood Loss During Endoprosthetic Replacement of Large Joints

Borisov,; Юдин, Владимир Александрович; Крылов, В. Н.; Markov, Boyan; Истомина, А И

doi:10.15360/1813-9779-2011-4-34

Cited by 4 publications

(2 citation statements)

References 10 publications

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“…Perioperative bleeding and blood loss are well known complications of total joint arthroplasty procedures 1,2 . Related but more invasive interventions used regularly in musculoskeletal oncology, such as wide resection of bony tumors and endoprosthetic reconstruction, carry even greater risk of substantial blood loss and often require perioperative blood transfusions 3 . Blood transfusions themselves are associated with increased morbidity including transfusion reaction, infection, and increased short‐term mortality; all of which can further increase the complexity of already high‐risk procedures 4,5 .…”

Section: Background and Objectivesmentioning

confidence: 99%

Tranexamic acid improves early postoperative mobilization in cancer patients undergoing endoprosthetic reconstruction

Haase

Mersereau

Kimbrel

et al. 2022

Journal of Surgical Oncology

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Background and Objectives: Tranexamic acid (TXA) has been shown to decrease perioperative blood loss, transfusions, and cost in patients undergoing resection of aggressive bone tumors and endoprosthetic reconstruction. This study explored the effect of TXA administration on postoperative mobilization in these patients.Methods: This study included 126 patients who underwent resection of an aggressive bone tumor and endoprosthetic reconstruction; 61 patients in the TXA cohort and 65 patients in the non-TXA cohort. Postoperative physical therapy (PT) and occupational therapy notes were reviewed; patient ambulation distance and duration of therapies were recorded.Results: Patients in the TXA cohort ambulated further on all postoperative days, which was significant on postoperative Day 1 (POD1) (p = 0.002) and postoperative Day 2 (POD2) (p < 0.001). The TXA cohort ambulated 85% further per PT session 87.7 versus 47.4 ft (p < 0.001) and participated 14% longer, 36.1 versus 31.7 min (p < 0.001). Multivariate analysis identified a significant inverse association between postoperative hospitalization length and POD1, POD2, postoperative Day 3, and total ambulation (p < 0.001). Blood transfusion was independently associated with a 1.5 day increase in postoperative hospitalization (95% confidence interval: 0.64-2.5; p < 0.001).Conclusions: TXA administration was associated with increased postoperative ambulation and endurance. Increased postoperative ambulation was associated with decreased length of stay and increased likelihood to discharge home.

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Section: Background and Objectivesmentioning

confidence: 99%

Tranexamic acid improves early postoperative mobilization in cancer patients undergoing endoprosthetic reconstruction

Haase

Mersereau

Kimbrel

et al. 2022

Journal of Surgical Oncology

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“…Extensive surgical resections and reconstructions for primary or metastatic bone tumors are associated with considerable blood loss and increased requirements for a blood transfusion [1][2][3]. Blood loss is associated with a high mortality risk, a high reoperation rate, an increased overall length of stay and increased hospital costs especially among anemic cancer patients [4].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Efficacy of Tranexamic Acid in Oncology Patients Undergoing Endoprosthetic Reconstruction and a ROTEM-Based Evaluation of Their Hemostatic Profile: A Pilot Study

Tsantes

Trikoupis

Papadopoulos

et al. 2021

Cancers

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Background: An endoprosthetic reconstruction in musculoskeletal oncology patients is associated with significant blood loss. The purpose of this study is to evaluate the safety and efficacy of tranexamic acid (TXA) for these patients and to assess any changes in their hemostatic profile using rotational thromboelastometry (ROTEM). Methods: A retrospective observational study was performed including 61 patients with primary or metastatic bone tumors who underwent surgery. Group A (n = 30) received both intravenous and local TXA whereas Group B (n = 31) was the control group. The primary outcomes were perioperative blood loss and blood unit transfusions and the secondary outcomes included the incidence of thromboembolic complications and a change in blood coagulability as reflected by ROTEM parameters. Results: The median difference in blood loss between the two groups was 548.5 mL, indicating a 29.2% reduction in the 72 h blood loss following TXA administration (p < 0.001). TXA also led to a reduced transfusion of 1 red blood cell (RBC) unit per patient (p < 0.001). The two groups had similar rates of thromboembolic complications (p = 0.99). The antifibrinolytic properties of TXA were confirmed by the significantly higher INTEM, FIBTEM and EXTEM LI60 (p < 0.001, p = 0.005 and p < 0.001, respectively) values in the TXA group. Conclusion: Tranexamic acid was associated with a significant reduction in perioperative blood loss and transfusion requirements without a complete shutdown of the fibrinolysis. Larger studies are warranted to assess the frequency of these outcomes in musculoskeletal oncology patients.

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Intravenous Tranexamic Acid Bolus plus Infusion Is Not More Effective than a Single Bolus in Primary Hip Arthroplasty

et al. 2017

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Background Preoperative administration of the antifibrinolytic agent tranexamic acid reduces bleeding in patients undergoing hip arthroplasty. Increased fibrinolytic activity is maintained throughout the first day postoperation. The objective of the study was to determine whether additional perioperative administration of tranexamic acid would further reduce blood loss. Methods This prospective, double-blind, parallel-arm, randomized, superiority study was conducted in 168 patients undergoing unilateral primary hip arthroplasty. Patients received a preoperative intravenous bolus of 1 g of tranexamic acid followed by a continuous infusion of either tranexamic acid 1 g (bolus-plus-infusion group) or placebo (bolus group) for 8 h. The primary outcome was calculated perioperative blood loss up to day 5. Erythrocyte transfusion was implemented according to a restrictive transfusion trigger strategy. Results The mean perioperative blood loss was 919 ± 338 ml in the bolus-plus-infusion group (84 patients analyzed) and 888 ± 366 ml in the bolus group (83 patients analyzed); mean difference, 30 ml (95% CI, −77 to 137; P = 0.58). Within 6 weeks postsurgery, three patients in each group (3.6%) underwent erythrocyte transfusion and two patients in the bolus group experienced distal deep-vein thrombosis. A meta-analysis combining data from this study with those of five other trials showed no incremental efficacy of additional perioperative administration of tranexamic acid. Conclusions A preoperative bolus of tranexamic acid, associated with a restrictive transfusion trigger strategy, resulted in low erythrocyte transfusion rates in patients undergoing hip arthroplasty. Supplementary perioperative administration of tranexamic acid did not achieve any further reduction in blood loss.

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Reduction of Perioperative Blood Loss During Endoprosthetic Replacement of Large Joints

Cited by 4 publications

References 10 publications

Tranexamic acid improves early postoperative mobilization in cancer patients undergoing endoprosthetic reconstruction

Tranexamic acid improves early postoperative mobilization in cancer patients undergoing endoprosthetic reconstruction

The Safety and Efficacy of Tranexamic Acid in Oncology Patients Undergoing Endoprosthetic Reconstruction and a ROTEM-Based Evaluation of Their Hemostatic Profile: A Pilot Study

Intravenous Tranexamic Acid Bolus plus Infusion Is Not More Effective than a Single Bolus in Primary Hip Arthroplasty

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