scholarly journals 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

2017 ◽  
Vol 25 (3) ◽  
pp. 230949901773162 ◽  
Author(s):  
Joo Hyun Park ◽  
Sung Wook Choi ◽  
Eun Ho Shin ◽  
Myung Hoon Park ◽  
Myung Ku Kim
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Low Dose ◽  
Reduce Blood Loss ◽  
Optimal Protocol ◽  
Total Knee ◽  
Drain Clamping

scholarly journals Patient specific instrumentation influences hemoglobin decrease after total knee replacement.

10.29007/f8h2 ◽  
2018 ◽  
Author(s):  
Davide Cucchi ◽  
Beatrice Zanini ◽  
Paolo Ferrua ◽  
Riccardo Compagnoni ◽  
Alessandra Menon ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Knee Replacement ◽  
Medullary Canal ◽  
Patient Specific ◽  
Reduce Blood Loss ◽  
Patient Specific Instrumentation ◽  
Significant Difference ◽  
Conventional Instrumentation ◽  
Total Knee

Patient Specific Instrumentation (PSI) may contribute to reduce blood loss after total knee replacement (TKR) by avoiding violation of the medullary canal. The purpose of the study was to compare the hemoglobin (Hb) decrease in two groups of patients undergoing TKR with PSI and conventional instrumentation.Pre- and post-operative blood samples were collected for twenty-two patients randomly assigned to receive a PSI-assisted or conventional TKR. Post- to preoperative Hb difference was calculated.A significant difference in Hb reduction in favor of the PSI group was registered on the last day of stay but not on the previous post-operative days: these promising results suggest a beneficial effect of PSI in blood loss reduction. PSI may hence be considered among the strategies available to control and reduce blood loss related to TKR.

scholarly journals Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Paphon Sa-ngasoongsong ◽  
Siwadol Wongsak ◽  
Noratep Kulachote ◽  
Pongsthorn Chanplakorn ◽  
Patarawan Woratanarat ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Predicting Factors ◽  
Total Knee ◽  
Low Bmi

Background.Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood loss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA.Materials and Methods.A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014). Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded 90th percentile.Results. From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the significant predictors of postoperative BT (p<0.0001and 0.003, resp.). Excessive THL significant associated with preoperative Hb (p<0.0001). Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05all). Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001and 0.002, resp.).Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

scholarly journals Comparison of Blood Loss using Intra-Articular Injection of Tranexamic Acid after Total Knee Replacement

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Aziz Sabbir Husain
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Transfusion Rate ◽  
Total Knee

Introduction:  Total knee replacement (TKR) is one of the most common surgeries in orthopedic field. Up to 1/3 of the patients require blood transfusion postoperative. Allogenic transfusion has many side effects. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent. We explore the usage of TXA in reducing blood loss and transfusion rate by injecting it into the knee joint during surgery.  Materials and method: This is a retrospective study done in Hospital Tengku Ampuan Rahimah, Klang. Medical records of patient undergoing TKR between 1 January 2018 till 31 December 2018 were reviewed. Study sample was calculated as 90 patients and divided into 2 groups, one receiving TXA (study) and the other not receiving TXA (control). Post-operative hemoglobin levels and transfusion rate was recorded.  Results: 45 patients in study group (17 male, 28 female) had a mean age of 65.4 years old and 45 patients in control group (24 male, 21 female) had a mean age of 64.2 years old. Mean post-operative hemoglobin drop in study group was 1.08 g/dL vs 1.86 g/dL in control group. Repeated measure ANOVA determined a p value of 0.001 which shows a significant correlation. Total transfusion rate in study group was 1 vs 9 in the control group. Using chi-square test, the p-value was 0.007 which again shows a statistically significant result.  Conclusion: Intra-articular injection of TXA following TKR reduces blood loss and the need for blood transfusion without increasing any complication. This prevents many patients from undergoing a potentially hazardous blood transfusion. A routine usage of intra-articular TXA in patients undergoing TKR is recommended. However a large and well designed RCT is required to investigate the risk and benefits of TXA.

scholarly journals Evaluation of tranexamic acid in reducing blood loss and transfusions in total knee replacement

2019 ◽  
Vol 5 (5) ◽  
pp. 899
Author(s):  
Mirza Atif Baig ◽  
Srujith Kommera
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Acid Group ◽  
Control Group ◽  
Blood Transfusions ◽  
Reduce Blood Loss ◽  
Transfusion Requirements ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Total knee replacement (TKR) is associated with substantial blood loss and thus the need for blood transfusions. Risks and costs of allogenic blood transfusions requires strategies to reduce blood loss in surgery. The objective of this study was to assess the efficacy of tranexamic acid treatment in reducing blood loss and blood transfusion requirements during TKR.</p><p class="abstract"><strong>Methods:</strong> A randomized controlled trial was conducted on 60 patients who were operated for unilateral TKR from January 2016 to January 2019 in Shadan Institute of Medical Sciences. 30 patients were in each control and study groups. In study group 12 mg/kg bolus of tranexamic acid was given as a slow IV dose, 40 minutes before deflation of tourniquet followed by 1.2 mg/kg/hr infusion for 12 hours with standard treatment of hospital and compared to the control group. Later blood loss was compared both intra and post operatively. Fall in haemoglobin after surgery was also compared.<strong></strong></p><p class="abstract"><strong>Results:</strong> Total blood loss in tranexamic acid group was 543.3±184.85<strong> </strong>ml (control group 685.83±176.74 ml) which is statistically significant (p&lt;0.05). Blood loss was markedly decreased in tranexamic acid group (379.16±174 ml in tranexamic acid vs. 513.33±143.89 ml in control group) statistically significant (p&lt;0.05).</p><p class="abstract"><strong>Conclusions:</strong> Tranexamic acid is an effective strategy to reduce blood loss in patients undergoing total knee replacement and thus minimizing the need for blood transfusions.</p>

Topical Intra-Articular Compared with Intravenous Tranexamic Acid to Reduce Blood Loss in Primary Total Knee Replacement

2014 ◽  
Vol 96 (23) ◽  
pp. 1937-1944 ◽  
Author(s):  
Enrique Gomez-Barrena ◽  
Miguel Ortega-Andreu ◽  
Norma G. Padilla-Eguiluz ◽  
Hanna Pérez-Chrzanowska ◽  
Reyes Figueredo-Zalve
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Reduce Blood Loss ◽  
Primary Total Knee Replacement ◽  
Total Knee ◽  
Primary Total Knee

scholarly journals An In Vivo Study of Low-Dose Intra-Articular Tranexamic Acid Application with Prolonged Clamping Drain Method in Total Knee Replacement: Clinical Efficacy and Safety

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Paphon Sa-ngasoongsong ◽  
Pongsthorn Chanplakorn ◽  
Siwadol Wongsak ◽  
Krisorn Uthadorn ◽  
Tanapong Panpikoon ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Low Dose ◽  
Postoperative Blood Loss ◽  
Systemic Absorption ◽  
Drainage Fluid ◽  
Significant Difference ◽  
Total Knee

Background. Recently, combined intra-articular tranexamic acid (IA-TXA) injection with clamping drain method showed efficacy for blood loss and transfusion reduction in total knee replacement (TKR). However, until now, none of previous studies revealed the effect of this technique on pharmacokinetics, coagulation, and fibrinolysis.Materials and Methods. An experimental study was conducted, during 2011-2012, in 30 patients undergoing unilateral TKR. Patients received IA-TXA application and then were allocated into six groups regarding clamping drain duration (2-, 4-, 6-, 8-, 10-, and 12-hours). Blood and drainage fluid were collected to measure tranexamic acid (TXA) level and related coagulation and fibrinolytic markers. Postoperative complication was followed for one year.Results. There was no significant difference of serum TXA level at 2 hour and 24 hour among groups(p<0.05). Serum TXA level at time of clamp release was significantly different among groups with the highest level at 2 hour(p<0.0001). There was no significant difference of TXA level in drainage fluid, postoperative blood loss, blood transfusion, and postoperative complications(p<0.05).  Conclusions. Low-dose IA-TXA application in TKR with prolonged clamping drain method is a safe and effective blood conservative technique with only minimal systemic absorption and without significant increase in systemic absorption over time.

scholarly journals Effect of intravenous tranexamic acid on blood loss and blood transfusion in total knee replacement: a prospective, randomized study in Indian population

2017 ◽  
Vol 3 (5) ◽  
pp. 916
Author(s):  
Shivakumar Kerakkanavar ◽  
Raghavendra Venkatesh ◽  
K. M. Gopinath ◽  
Pramodkumar M.
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Primary Total Knee Replacement ◽  
Group I ◽  
Total Knee ◽  
Group Ii ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Tranexamic acid (TXA) is antifibrinolytic drug which has the property to reduce intraoperative and postoperative bleeding. There are several studies supporting the use of tranexamic acid in total knee replacements (TKR) and few in total hip replacements. Our study was intended to establish the effects of tranexamic acid in minimizing the intra operative and post-operative blood loss in uncomplicated primary total knee replacement.</p><p class="abstract"><strong>Methods:</strong> This was a prospective follow up study conducted in Rajarajeshwari Medical College and Hospital Bangalore, over a period of 14 months from June 2015 to August 2016. A total number of 60 patients who underwent unilateral primary total knee replacement were included for this study. They were randomly divided into 2 groups. Group I patients infused (intravenous) with 20 mg/kg TXA before incision and 3 hours after surgery whereas no TXA was administered in Group II. Total blood loss and transfusion rate were used as outcome. <strong></strong></p><p class="abstract"><strong>Results:</strong> Mean amounts of blood loss were 578 ml in Group 1 and 946 ml in Group 2. There was a decrease in blood loss in TXA groups (p&lt;0.001). Transfusion was required in 6 patients of Group I and 17 patients of Group II (p&lt;0.001). No thromboembolic problem was seen in any patients.</p><p><strong>Conclusions:</strong> Since TXA decrease perioperative blood loss and lessen the need for blood transfusion significantly, without increasing thromboembolic events in TKR. We suggest using intravenous (IV) TXA in TKR. </p>

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