Regional Hemostatic Status and Blood Requirements After Total Knee Arthroplasty With and Without Tranexamic Acid or Aprotinin

Engel, J.; Hohaus, Tove; Ruwoldt, Ralph; Menges, T.; Jürgensen, Imke; Hempelmann, G.

doi:10.1097/00000539-200103000-00041

Cited by 35 publications

(20 citation statements)

References 16 publications

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“…Various studies have proposed the use of aprotinin (natural) and tranexamic acid (synthetic) as antifibrinolytic agents to reduce blood loss and transfusion requirements in orthopedic surgery 3031. Evaluations on the effectiveness of tranexamic acid on reducing postoperative blood loss in TKA have had varying outcomes 3233. However, in studies that have shown effectiveness for tranexamic acid, the reduction in hemoglobin and hematocrit is similar to that achieved by the hemostatic matrix in the current study 34.…”

Section: Discussionmentioning

confidence: 55%

Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Francesco

Flamini

Fiori

et al. 2013

IJOO

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Background:Total knee arthroplasty (TKA) can result in major postoperative blood loss which can impact on the recovery and rehabilitation of patients. It also requires expensive transfusions. The purpose of the study was to investigate whether a hemostatic matrix, composed of cross-linked gelatin and a thrombin solution, would reduce blood loss in patients following TKA.Materials and Methods:This was a prospective, randomized, controlled study (Trial registration: Hospital S. Salvatore L’Aquila ADJ00843) conducted in 93 patients. Criteria for participation were unilateral TKA for osteoarthritis, and a preoperative hemoglobin level >13 g/dL. The outcomes measured were postoperative hemoglobin and hematocrit levels measured at 24h, 72 h, and 7 days. The mean total postoperative blood loss was calculated from drainage volume, patient blood volume, hematocrit, and red blood cell volume. In addition, the drain output within 24 h following surgery and any transfusion requirements were determined.Results:Hemostatic matrix-treated patients (n = 51) showed significant reductions in calculated postoperative blood loss of 32.3% and 28.7% versus control in men and women, respectively (P < 0.01). Postoperative blood loss after 24 h in drain was significantly less with the hemostatic matrix versus control, as were decreases in hemoglobin levels 7 days post-surgery (each P < 0.01). Three patients in the control group required blood transfusion, whereas no blood transfusions were necessary in the hemostatic matrix group.Conclusion:The use of a hemostatic matrix provides a safe and effective means to reduce blood loss and blood transfusion requirements in TKA.

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Section: Discussionmentioning

confidence: 55%

Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Francesco

Flamini

Fiori

et al. 2013

IJOO

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“…A few studies have shown, if the blood loss in the control group is 1 L or less [9,10,18], the effect of tranexamic acid will not be appreciable. Despite the loss in the control group being approximately 1 L in our patients, the POIO and POIOPO regimens still showed a reduction in drain loss and total blood loss.…”

Section: Discussionmentioning

confidence: 99%

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Maniar

Kumar²,

Singhi

et al. 2012

Clinical Orthopaedics &Amp; Related Research

275

258

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Background The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. Questions/purposes We studied different dosages, timings, and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA. Methods We prospectively studied five regimens (four intravenous, one local; 40 patients each) with a control group (no tranexamic acid). The four intravenous (10-mg/kg dose) regimens included (1) intraoperative dose (IO) given before tourniquet deflation, (2) additional preoperative dose (POIO), (3) additional postoperative dose (IOPO), and (4) all three doses (POIOPO). The fifth regimen was a single local application (LA). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method, were evaluated statistically. Results Both parameters were reduced in all five regimens as against the control. A significant reduction in drain loss was seen in the POIO, IOPO, and POIOPO groups whereas total blood loss was significantly reduced in the POIO, POIOPO, and LA groups. The POIOPO group had the least drain loss (303 mL) and least total blood loss (688 mL). The IO group had the greatest drain loss and the IOPO group the greatest total blood loss. Conclusions Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.

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“…In recent years the use of antifibrinolytic medications such as tranexamic acid (TXA) to decrease blood loss and transfusion has slowly gained popularity in orthopaedics [9,19]. Multiple prospective trials involving patients undergoing TJA have demonstrated a reduction in blood loss and transfusion rates with both TXA and e-aminocaproic acid (EACA) [1,2,4,8,17,20,21,25,26,28]. These results have been One of the authors (MWP) certifies that he has or may receive payments or benefits, in any one year, an amount in excess of USD 100,000 from DePuy (Warsaw, IN, USA), MAKO Surgical Corp (Ft Lauderdale, FL, USA), and Stryker Orthopaedics (Mahwah, NJ, USA).…”

Section: Introductionmentioning

confidence: 99%

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

Whiting

Gillette

Duncan

et al. 2014

Clinical Orthopaedics &Amp; Related Research

103

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Regional Hemostatic Status and Blood Requirements After Total Knee Arthroplasty With and Without Tranexamic Acid or Aprotinin

Cited by 35 publications

References 16 publications

Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Hemostatic matrix effects on blood loss after total knee arthroplasty: A randomized controlled trial

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Preliminary Results Suggest Tranexamic Acid is Safe and Effective in Arthroplasty Patients with Severe Comorbidities

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