Thrombin-Based Hemostatic Agent in Primary Total Knee Arthroplasty

Abstract

The present meta-analysis pooled the results from randomized controlled trials (RCTs) to identify and assess the efficacy and safety of thrombin-based hemostatic agent in primary total knee arthroplasty (TKA). Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5), and ScienceDirect (1966-2015.5). Relevant journals and the recommendations of expert panels were also searched by using Google search engine. RCTs assessing the efficacy and safety of thrombin-based hemostatic agent in primary TKA were included. Pooling of data was analyzed by RevMan 5.1 (The Cochrane Collaboration, Oxford, UK). A total of four RCTs met the inclusion criteria. The meta-analysis revealed significant differences in postoperative hemoglobin decline ( < 0.00001), total blood loss ( < 0.00001), drainage volume ( = 0.01), and allogenic blood transfusion ( = 0.01) between the treatment group and the control group. No significant differences were found regarding incidence of infection ( = 0.45) and deep vein thrombosis (DVT; = 0.80) between the groups. Meta-analysis indicated that the application of thrombin-based hemostatic agent before wound closure decreased postoperative hemoglobin decline, drainage volume, total blood loss, and transfusion rate and did not increase the risk of infection, DVT, or other complications. Therefore, the reviewers believe that thrombin-based hemostatic agent is effective and safe in primary TKA.

Scalpel can achieve better clinical outcomes compared with electric cautery in primary total knee arthroplasty: a comparison study

“…Similarly, studies have confirmed that topical use of TXA can obtain similar clinical effects as intravenous use of TXA, and the less possibility of complications [20,21]. In addition, other studies have pointed out that the topical use of the hemostatic agent, such as Floseal®, has achieved significant results in controlling blood loss during TKA [22][23][24][25]. In the present study, in order to reduce the related complications caused by blood loss, all of our patients have combined intravenous and topical use of TXA.…”

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

“…Hb decrease can be associated with medical short-and long-term complications and numerous strategies were developed to reduce blood loss during TKA. 2,[4][5][6][7][8][9][10][11][12] Violation of the medullary canal may increase the risk of perioperative blood loss and embolization of medullary content. PSI overcomes this need, making reasonable to expect a reduction in blood loss.…”

Advances in Topical Hemostatic Agent Therapies: A Comprehensive Update

“…A meta-analysis indicated that thrombin-based hemostatic agent applied before wound closure decreased postoperative blood loss and transfusion rate without elevated risk of infection, deep vein thrombosis, or other complications [4]. Fu et al revealed that a thrombin-based hemostatic agent is effective in primary total knee arthroplasty [23]. However, the utility of thrombin-based hemostatic agents to reduce transfusions remains controversial [23].…”

“…Fu et al revealed that a thrombin-based hemostatic agent is effective in primary total knee arthroplasty [23]. However, the utility of thrombin-based hemostatic agents to reduce transfusions remains controversial [23].…”