Topical tranexamic acid and periarticular infiltration vs topical administration for the reduction of blood loss in knee arthroplasty. a cohort study
DOI:
https://doi.org/10.1016/j.rccot.2021.02.012Keywords:
total knee arthroplasty, tranexamic acid, periarticular infiltration, blood lossAbstract
Introduction: The tranexamic acid is currently one of the most effective pharmacological methods for blood lose in articular replacements. The study aimed to evaluate the effects of TXA administration in periarticular infiltration combined with intraarticular administration compared to topical TXA in blood lose in total knee arthoplasty.
Methods: Retrospective observational study. Patients undergoing total primary knee arthoplasty were included. Hematocrit and pre-surgical and post-surgical hemoglobin values ??were collected in patients operated between March 2016 and March 2018. The first group underwent peripheral joint infiltration with bupivacaine mixture with epinephrine 150 mg, ketorolac 30 mg, morphine 0.1 mg / kg and 2 g. of intraarticular TXA; the second group administered the same previous protocol plus 1 g. of TXA in the infiltrated mixture.
Outcomes: 174 patients [Group 1: 174 (65.9%) and Group 2: 90 (34.1%)]. From group 1, the percentage of transfusion was 0.57% (1 patient). The average decrease in hematocrit was 7.03% (-1.4 to 18.3) and the decrease in hemoglobin from 2.51 (-0.5 to -5.7) g / dl. In group 2 there were no transfusions. The average decrease in hematocrit was 7.05 (-0.3 to 15.1) and the decrease in hemoglobin of 2.56 (0.0-5.2) g / dl.
Discussion: The results of our study are similar to reports from previous studies. The use of TXA in the mixture of periarticular infiltration in addition to its topical use does not generate benefit in the control of blood loss in the total knee arthroplasty.
Evidence: III
Downloads
References
Barr PJ, Donnelly M, Cardwell C, Alam SS, Morris K, Parker M, et al. Drivers of Transfusion Decision Making and Quality of the Evidence in Orthopedic Surgery: A Systematic Review of the Literature. Transfus Med Rev. 2011;25:304-16, https://doi.org/10.1016/j.tmrv.2011.04.003, e6.
Vamvakas EC, Blajchman MA. Transfusion-related mortality: the ongoing risks of allogeneic blood transfusion and the available strategies for their prevention. Blood. 2009;113:3406e17. https://doi.org/10.1182/blood-2008-10-167643
Pitta M, Zawadsky M, Verstraete R, Rubinstein A. Blood management. 2016;56:1-6.
Mi B, Liu G, Zhou W, Lv H, Liu Y, Zha K, et al. Intra-articular versus intravenous tranexamic acid application in total knee arthroplasty: a meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg. 2017;137:997e1009.https://doi.org/10.1007/s00402-017-2683-1
Chen TP, Chen YM, Jiao JB, Wang YF, Qian LG, Guo Z, et al. Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12:11. https://doi.org/10.1186/s13018-017-0512-4
Wang S, Gao X, An Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Int Orthop. 2017;41:739e48. https://doi.org/10.1007/s00264-016-3296-y
Iii GNG, Galindo RP, Marino J, Fred D, Scuderi GR. Peri-Articular Regional Analgesia in Total Knee Arthroplasty. A Review of The Neuroanatomy And Injection Technique. 2014;2:1-6.
Yozawa S, Ogawa H, Matsumoto K. Periarticular Injection of Tranexamic Acid Reduces Blood Loss and the Necessity for Allogeneic Transfusion After Total Knee Arthroplasty Using Autologous Transfusion?: A Retrospective Observational Study. J Arthroplasty [Internet]. 2018;33:86-9, https://doi.org/10.1016/j.arth.2017.08.018
Okamoto SOU. Amino-methyl-cyclohexane-carboxylic acid: AMCHA. A new potent inhibitor of fibrinolysis. Keio J Med. 1962;11:105-15. https://doi.org/10.2302/kjm.11.105
Okamoto SSS, Takada Y, Okamoto U. An Active Stereo-Isomer (Trans-Form) of Amcha and Its Antifibrinolytic (Antiplasminic) Action in Vitro and in Vivo. Keio J Med. 1964;13:177-85. https://doi.org/10.2302/kjm.13.177
Benoni G, Carlsson A, Petersson C, Fredin H. Does tranexamic acid reduce blood loss in knee arthroplasty? Am J Knee Surg. 1995;8:88-92.
Alshryda S, Mason J, Vaghela M, Sarda P, Nargol A, Maheswaran S, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). The Journal of bone and joint surgery American volume. 2013;95:1961-8. https://doi.org/10.2106/JBJS.L.00907
Alshryda S, Mason J, Sarda P, Nargol A, Cooke N, Ahmad H, et al. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total hip replacement: a randomized controlled trial (TRANX-H). The Journal of bone and joint surgery American volume. 2013;95:1969-74. https://doi.org/10.2106/JBJS.L.00908
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 3.0 Unported License.
Derechos de autor
Los autores aceptar transferir a la Revista Colombiana de Ortopedia y Traumatología los derechos edición, publicación y reproducción de los artículos publicados. La editorial tiene el derecho del uso, reproducción, transmisión, distribución y publicación en cualquier forma o medio. Los autores no podrán permitir o autorizar el uso de la contribución sin el consentimiento escrito de la revista. Una vez firmada por todos los autores, la carta de Cesión de derechos debe ser cargada en el paso dos del envío.
Aquellos autores que tengan publicaciones en esta revista aceptan los siguientes términos:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web), lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
