A Comparative Study of the Postoperative Allogeneic Blood-Sparing Effect of Tranexamic Acid Versus Acute Normovolemic Hemodilution After Total Knee Replacement

AbstractPerioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was given preoperatively. Patients of Group C (n 3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly, in Group D (n 4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative and discharge hemoglobin together with total units of blood transfusion and creatinine levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82 units/patient, p < 0.001, CI 95%) in contrast to the two regimens of erythropoietin (1.16 units/patient) OrthoPAT (1.43 units/patient) and restrictive strategies (1.92 units/patient). The mean preoperative hemoglobin was 13.37 g/dL with no statistical difference among the groups of patients. The postoperative mean hemoglobin was 10.59 with no statistical difference among the groups of patients too. Additionally, the mean creatinine level was 0.93 mg/dL; however, no statistical difference among the groups of patients was noted. Finally, tranexamic acid seemed to be the most cost-effective regime. In our study, tranexamic acid proved its superiority concerning the postoperative blood transfusion on patients undergoing total knee replacement, in comparison with the other existing methods of perioperative blood management. This is a Level III, retrospective comparative study.

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A randomized comparative study of topical versus intravenous tranexamic acid administration in enhanced recovery after surgery (ERAS) total knee replacement

Journal of Orthopaedics ◽

10.1016/j.jor.2016.03.007 ◽

2016 ◽

Vol 13 (3) ◽

pp. 127-131 ◽

Cited By ~ 22

Author(s):

Georgios I. Drosos ◽

Athanasios Ververidis ◽

Christos Valkanis ◽

Grigorios Tripsianis ◽

Eftihios Stavroulakis ◽

...

Keyword(s):

Total Knee Replacement ◽

Tranexamic Acid ◽

Comparative Study ◽

Knee Replacement ◽

Enhanced Recovery ◽

Enhanced Recovery After Surgery ◽

Total Knee ◽

Acid Administration

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A comparative study of the postoperative allogeneicblood-sparing effects of tranexamic acid and of desmopressin after total knee replacement

Transfusion ◽

10.1046/j.1537-2995.2001.41101285.x ◽

2001 ◽

Vol 41 (10) ◽

pp. 1285-1289 ◽

Cited By ~ 29

Author(s):

Edna Zohar ◽

Brian Fredman ◽

Martin H. Ellis ◽

Nisim Ifrach ◽

Avraham Stern ◽

...

Keyword(s):

Total Knee Replacement ◽

Tranexamic Acid ◽

Comparative Study ◽

Knee Replacement ◽

Total Knee

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Topical (Intra-Articular) Tranexamic Acid Reduces Blood Loss and Transfusion Rates Following Total Knee Replacement

The Journal of Bone and Joint Surgery (American) ◽

10.2106/jbjs.l.00907 ◽

2013 ◽

Vol 95 (21) ◽

pp. 1961-1968 ◽

Cited By ~ 103

Author(s):

Sattar Alshryda ◽

James Mason ◽

Manesh Vaghela ◽

Praveen Sarda ◽

Antoni Nargol ◽

...

Keyword(s):

Blood Loss ◽

Total Knee Replacement ◽

Tranexamic Acid ◽

Knee Replacement ◽

Total Knee

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Autologous blood transfusion in total knee replacement surgery

Vojnosanitetski pregled ◽

10.2298/vsp1303274l ◽

2013 ◽

Vol 70 (3) ◽

pp. 274-278 ◽

Cited By ~ 6

Author(s):

Mirka Lukic-Sarkanovic ◽

Ljiljana Gvozdenovic ◽

Dragan Savic ◽

Miroslav Ilic ◽

Gordana Jovanovic

Keyword(s):

Blood Transfusion ◽

Total Knee Replacement ◽

Knee Replacement ◽

Autologous Blood ◽

Allogeneic Blood ◽

Autologous Blood Transfusion ◽

Knee Replacement Surgery ◽

Replacement Surgery ◽

Total Knee Replacement Surgery ◽

Total Knee

Background/Aim. Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. Methods. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people?s (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. Results. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p ? 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). Conclusion. Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

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