The optimal protocol to reduce blood loss and blood transfusion after unilateral total knee replacement: Low-dose IA-TXA plus 30-min drain clamping versus drainage clamping for the first 3 h without IA-TXA

Park, Joo Hyun; Choi, Sung Wook; Shin, Eui-Su; Park, Myung Hoon; Kim, Myung Ku

doi:10.1177/2309499017731626

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…Raleigh et al concluded that clamping drains intermittently resulted in significantly less postoperative drainage than that observed with continuous suction drainage [37]. Park et al found that intraarticular tranexamic acid administration plus 30-min drain clamping also significantly reduced postoperative drainage [38].…”

Section: Discussionmentioning

confidence: 99%

The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis

et al. 2019

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BackgroundThe tourniquet is a common medical instrument used in total knee arthroplasty (TKA). However, there has always been a debate about the use of a tourniquet and there is no published meta-analysis to study the effects of a tourniquet on blood loss in primary TKA for patients with osteoarthritis.MethodsWe performed a literature review on high-quality clinical studies to determine the effects of using a tourniquet or not on blood loss in cemented TKA. PubMed, Web of Science, MEDLINE, Embase, and the Cochrane Library were searched up to November 2018 for relevant randomized controlled trials (RCTs). We conducted a meta-analysis following the guidelines of the Cochrane Reviewer’s Handbook. We used the Cochrane Collaboration’s tool for assessing the risk of bias of each trial. The statistical analysis was performed with Review Manager statistical software (version 5.3).ResultsEleven RCTs involving 541 patients (541 knees) were included in this meta-analysis. There were 271 patients (271 knees) in the tourniquet group and 270 patients (270 knees) in the no tourniquet group. The results showed that using a tourniquet significantly decreased intraoperative blood loss (P < 0.002), calculated blood loss (P < 0.002), and the time of operation (P < 0.002), but tourniquet use did not significantly decrease postoperative blood loss (P > 0.05), total blood loss (P > 0.05), the rate of transfusion (P > 0.05), and of deep vein thrombosis (DVT) (P > 0.05) in TKA.ConclusionsUsing a tourniquet can significantly decrease intraoperative blood loss, calculated blood loss, and operation time but does not significantly decrease the rate of transfusion or the rate of DVT in TKA. More research is needed to determine if there are fewer complications in TKA without the use of tourniquets.

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Section: Discussionmentioning

confidence: 99%

The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis

et al. 2019

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“…Different measures to reduce operative blood loss have been employed in orthopedic surgery to reduce the need for transfusion and hasten the patient's recovery in the post-operative period [2]. A frequently employed such technique is transfusion of autologous blood which also reduces the risk of infection, but it is expensive and not every center has the facility [2,3]. Another method for control of the perioperative blood loss is the application of anti-fibrinolytic agents including aprotinin, epsilon-aminocaproic acid, and tranexamic acid (TXA) [4].…”

Section: Discussionmentioning

confidence: 99%

“…During TKA, Patient's recovery may be affected negatively by blood loss. Allogenic blood transfusion may be needed on the basis of amount of blood lost during the procedure [2]. Moreover, high post-operative infections are also associated with this procedure [3], measures which can reduce operative loss of blood and subsequent necessitating blood transfusion have always been adored and a hot focus of medical research [2].…”

Section: Introductionmentioning

confidence: 99%

Comparison of blood loss between intra-articular and intra-venous administration of tranexamic acid in primary total knee arthroplasty

Amin¹,

Habib

Rehman

2020

SICOT-J

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Objective: To compare the blood loss between intra-articular and intra-venous administration of tranexamic acid (TXA) in patients undergoing primary total knee arthroplasty. Design of study: It was a randomized controlled trial. Study duration and settings: This study was carried out at the Orthopedic Departments of Combined Military Hospital Lahore and Rawalpindi from Jan 2016 to March 2018. Methodology: Patients of both the genders were involved this study who had age in the rage of 40–80 years undergoing primary unilateral total knee arthroplasty for degenerative conditions like osteoarthritis and rheumatoid arthritis. These patients were randomly divided into two treatment groups. Patients in IA group received intra-articular tranexamic acid while those in IV group received intravenous tranexamic acid. From all the patients, a written signed consent was taken. Findings: Females were predominant with male-to-female ratio of 1:3.7. The mean age of the patients was 67.3 ± 8.2 years while the mean BMI was 30.9 ± 2.9 Kg/m2. Majority (n = 191, 95.5%) of the patients had osteoarthritis while remaining 9 (4.5%) patients had rheumatoid arthritis. There was no statistically significant difference between intra-articular and intra-venous administration of tranexamic acid in terms of mean post-operative hemoglobin (9.93 ± 1.14 vs. 9.87 ± 1.26 g/dL; p-value = 0.724), mean post-operative hematocrit (34.8 ± 1.66 vs. 34.73 ± 1.27%; p-value = 0.594), and mean fall in hemoglobin (2.27 ± 0.34 vs. 2.25 ± 0.30 g/dL; p-value = 0.587) and hematocrit (2.34 ± 0.94 vs. 2.46 ± 0.28%; p-value = 0.216). Conclusion: Intra-articular administration of tranexamic acid was found to be as effective and safe as intra-venous administration in reducing blood loss in primary total knee arthroplasty. Due to convenience, the use of intra-articular administration of tranexamic acid after primary TKA may be considered in future practice.

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“…Different measures are used to reduce intra operative blood loss have been employed in orthopedic surgery to reduce the need for transfusion and hasten the patient's recovery in the post-operative period [9]. One technique is transfusion of autologous blood which also reduces the risk of infection and risk of transfusion reaction but it is expensive and not every center has facility for this [9,10]. Another technique to reduce perioperative blood loss is the application of antifibrinolytic agents including aprotinin, epsilonaminocaproic acid, and tranexamic acid (TXA).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Intravenous and Intra-Articular Use of Tranexamic Acid on Blood Loss after Primary Total Knee Arthroplasty

Singh¹,

Kaur²

2020

SJAMS

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The optimal protocol to reduce blood loss and blood transfusion after unilateral total knee replacement: Low-dose IA-TXA plus 30-min drain clamping versus drainage clamping for the first 3 h without IA-TXA

Cited by 10 publications

References 31 publications

The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis

The effects of tourniquet use on blood loss in primary total knee arthroplasty for patients with osteoarthritis: a meta-analysis

Comparison of blood loss between intra-articular and intra-venous administration of tranexamic acid in primary total knee arthroplasty

Comparison of Intravenous and Intra-Articular Use of Tranexamic Acid on Blood Loss after Primary Total Knee Arthroplasty

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