3-h drain clamping is not effective to reduce total blood loss after primary total knowledge

Abstract Background Although excellent clinical outcomes of supercapsular percutaneously assisted total hip arthroplasty (SuperPath) have been reported, the peri-operative blood loss has rarely been reported. The current study determined the blood loss during SuperPath and compared the blood loss with conventional posterolateral total hip arthroplasty (PLTH). Methods This retrospective study enrolled patients who underwent unilateral primary THA between January 2017 and December 2019. The demographic data, diagnoses, affected side, radiographic findings, hemoglobin concentration, hematocrit, operative time, transfusion requirements, and intra-operative blood loss were recorded. The peri-operative blood loss was calculated using the OSTHEO formula. Blood loss on the 1st, 3rd, and 5th post-operative days was calculated. Hidden blood loss (HBL) was determined by subtracting the intra-operative blood loss from the total blood loss. Results Two hundred sixty-three patients were included in the study, 85 of whom were in the SuperPath group and 178 in the posterolateral total hip arthroplasty (PLTH) group. Patient demographics, diagnoses, affected side, operative times, and pre-operative hemoglobin concentrations did not differ significantly between the two groups (all P > 0.05). Compared to the PLTH group, the SuperPath group had less blood loss, including intra-operative blood loss, 1st, 3rd, and 5th post-operative days blood loss, and HBL (all P < 0.05). Total blood loss and HBL was 790.07 ± 233.37 and 560.67 ± 195.54 mL for the SuperPath group, respectively, and 1141.26 ± 482.52 and 783.45 ± 379.24 mL for the PLTH group. PLTH led to a greater reduction in the post-operative hematocrit than SuperPath (P < 0.001). A much lower transfusion rate (P = 0.028) and transfusion volume (P = 0.019) was also noted in the SuperPath group. Conclusion SuperPath resulted in less perioperative blood loss and a lower transfusion rate than conventional PLTH.

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3D-printed models for periacetabular osteotomy surgical planning

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab024 ◽

2021 ◽

Author(s):

B Keegan Markhardt ◽

Matthew A Beilfuss ◽

Scott J Hetzel ◽

David C Goodspeed ◽

Andrea M Spiker

Keyword(s):

Radiation Dose ◽

Blood Loss ◽

Surgical Planning ◽

Preoperative Planning ◽

Periacetabular Osteotomy ◽

Total Blood Loss ◽

Preoperative Imaging ◽

Total Blood ◽

Patient Age ◽

3D Printed

Abstract The purpose of this study was to determine the feasibility and clinical benefits of using 3D-printed hemipelvis models for periacetabular osteotomy preoperative planning in the treatment of hip dysplasia. This retrospective study included 28 consecutive cases in 26 patients, with two bilateral cases, who underwent periacetabular osteotomy between January 2017 and February 2020 and had routine radiographs, CT and MR imaging. Of these, 14 cases [mean patient age 30.7 (SD 8.4) years, 11 female] had routine preoperative imaging, and 14 cases [mean patient age 28.0 (SD 8.7) years, 13 female] had routine preoperative imaging and creation of a full-scale 3D-printed hemipelvis model from the CT data. The expected surgical cuts were performed on the 3D-printed models. All patients underwent Bernese periacetabular osteotomy. Operative times, including time to achieve proper acetabular position and total periacetabular osteotomy time, fluoroscopy radiation dose and estimated total blood loss were compiled. ANOVA compared outcome variables between the two patient groups, controlling for possible confounders. On average, patients who had additional preoperative planning using the 3D-printed model had a 5.5-min reduction in time to achieve proper acetabular position and a 14.5-min reduction in total periacetabular osteotomy time; however, these changes were not statistically significant (P = 0.526 and 0.151, respectively). No significant difference was identified in fluoroscopy radiation dose or total blood loss. Detailed surgical planning for periacetabular osteotomy using 3D-printed models is feasible using widely available and affordable technology and shows promise to improve surgical efficiency.

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Evaluating the Role of Anesthesia on Intraoperative Blood Loss and Visibility during Endoscopic Sinus Surgery: A Meta-analysis

American Journal of Rhinology and Allergy ◽

10.1177/1945892421989155 ◽

2021 ◽

pp. 194589242198915

Author(s):

David C. Moffatt ◽

Robert A. McQuitty ◽

Alex E. Wright ◽

Tawanda S. Kamucheka ◽

Ali L. Haider ◽

...

Keyword(s):

Heart Rate ◽

Blood Loss ◽

Endoscopic Sinus Surgery ◽

Average Rate ◽

Meta Analysis ◽

Sinus Surgery ◽

Total Blood Loss ◽

Total Blood ◽

Intraoperative Bleeding ◽

Significant Difference

Background Previous studies and meta analyses have led to incongruent and incomplete results respectively when total intravenous anesthesia (TIVA) and inhalational anesthesia (IA) are compared in endoscopic sinus surgeries in regards to intraoperative bleeding and visibility. Objective To perform a more comprehensive meta-analysis on randomized controlled trial (RCTs) comparing TIVA with IA in endoscopic sinus surgery to evaluate their effects on intraoperative bleeding and visibility. Methods A systematic review and meta-analysis of studies comparing TIVA and IA in endoscopic sinus surgery for chronic rhinosinusitis was completed in May 2020. Utilizing databases, articles were systematically screened for analysis and 19 studies met our inclusion criteria. The primary outcome included intraoperative visibility scores combining Boezaart, Wormald and Visual Analogue Scale (VAS). Secondary outcomes included rate of blood loss (mL/kg/min), estimated total blood loss (mL), Boezaart, Wormald scores, VAS, heart rate, and mean arterial pressure (MAP). Results 19 RCTs with 1,010 patients were analyzed. TIVA had a significantly lower intraoperative bleeding score indicating better endoscopic visibility (Boezaart, VAS, and Wormald) than IA (−0.514, p = 0.020). IA had a significantly higher average rate of blood loss than TIVA by 0.563 mL/kg/min (p = 0.016). Estimated total blood loss was significantly lower in TIVA than IA (−0.853 mL, p = 0.002). There were no significant differences between TIVA and IA in the mean heart rate (−0.225, p = 0.63) and MAP values (−0.126, p = 0.634). The subgroup analyses revealed no significant difference between TIVA and IA when remifentanil was not utilized and whenever desflurane was the IA agent. Conclusion TIVA seemed to have superior intraoperative visibility scores and blood loss during endoscopic sinus surgery when compared to IA. However, the results are not consistent when stratifying the results based on the use of remifentanil and different inhaled anesthetics. Therefore, the conclusion cannot be made that one approach is superior to the other.

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Systemic or topical application of plasminogen activator inhibitor with extended half-life (VLHL PAI-1) reduces bleeding time and total blood loss

International Journal of Molecular Medicine ◽

10.3892/ijmm_00000491 ◽

2010 ◽

Vol 26 (4) ◽

Cited By ~ 6

Author(s):

Jankun

Keyword(s):

Blood Loss ◽

Plasminogen Activator ◽

Topical Application ◽

Half Life ◽

Bleeding Time ◽

Plasminogen Activator Inhibitor ◽

Total Blood Loss ◽

Total Blood ◽

Activator Inhibitor ◽

Pai 1

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Uterine Balloon Tamponade in Combination with Topical Administration of Tranexamic Acid for Management of Postpartum Hemorrhage

Case Reports in Obstetrics and Gynecology ◽

10.1155/2015/195036 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Masato Kinugasa ◽

Hanako Tamai ◽

Mayu Miyake ◽

Takashi Shimizu

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Postpartum Hemorrhage ◽

Balloon Catheter ◽

Stable Condition ◽

Total Blood Loss ◽

Total Blood ◽

Balloon Tamponade ◽

First Case ◽

Uterine Balloon Tamponade

While uterine balloon tamponade is an effective modality for control of postpartum hemorrhage, the reported success rates have ranged from the level of 60% to the level of 80%. In unsuccessful cases, more invasive interventions are needed, including hysterectomy as a last resort. We developed a modified tamponade method and applied it to two cases of refractory postpartum hemorrhage after vaginal delivery. The first case was accompanied by uterine myoma and low-lying placenta. After an induced delivery, the patient had excessive hemorrhage due to uterine atony. Despite oxytocin infusion and bimanual uterine compression, the total blood loss was estimated at 2,800 mL or more. The second case was diagnosed as placental abruption complicated by fetal death and severe disseminated intravascular coagulation, subsequently. A profuse hemorrhage continued despite administration of uterotonics, fluid, and blood transfusion. The total blood loss was more than 5,000 mL. In each case, an intrauterine balloon catheter was wrapped in gauze impregnated with tranexamic acid, inserted into the uterus, and inflated sufficiently with sterile water. In this way, mechanical compression by a balloon and a topical antifibrinolytic agent were combined together. This method brought complete hemostasis and no further treatments were needed. Both the women left hospital in stable condition.

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Does the correction angle affect hidden blood loss in HTO?

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02071-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zheng Li ◽

Yannong Wang ◽

Guanglei Cao ◽

Shuai An ◽

Mingli Feng ◽

...

Keyword(s):

Clinical Practice ◽

Blood Loss ◽

High Tibial Osteotomy ◽

Total Blood Loss ◽

Tibial Osteotomy ◽

Open Wedge ◽

Total Blood ◽

Correction Angle ◽

Hidden Blood Loss ◽

Wedge High Tibial Osteotomy

Abstract Background High tibial osteotomy (HTO) has a history of nearly 60 years and has been widely used in clinical practice. Biplanar open wedge high tibial osteotomy (BOWHTO), which evolved from HTO, is an important therapy for the knee osteoarthritis. In our previous research, we found that the decrease of hemoglobin levels after high tibial osteotomy ranges from between 17 to 41 g/L, but this is highly inconsistent with the intraoperative bleeding and postoperative drainage observed in clinical practice. The purpose of this study was to investigate the perioperative hidden blood loss (HBL) after biplanar open wedge high tibial osteotomy (BOWHTO), as well as to study the effect of the actual correction angle on blood loss. Methods A retrospective analysis was performed on 21 patients who underwent BOWHTO for osteoarthritis of the knee due to proximal tibia deformity. Gross equation was used to calculate the perioperative total blood loss (TBL) and HBL. The actual correction angle was measured by postoperative anteroposterior radiograph. The correlation between HBL and correction angle was determined through correlation analysis. Results The TBL was 823.5 ± 348.7 mL and the HBL was 601.6 ± 297.3 mL, total hemoglobin loss was 25.0 ± 10.7 g/L, and the mean HBL/patient’s blood volume (H/P) was 13.19 ± 5.56% for 21 patients. The correlation coefficient of correction angle and H/P is statistically significant (|r| = 0.678, P = 0.001). Conclusions The actual total blood loss after BOWHTO was significantly higher than the observed, and the HBL was objective existent after BOWHTO. The proportion of H/P is positively correlated with the correction angle.

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Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2018-024350 ◽

2019 ◽

Vol 9 (1) ◽

pp. e024350 ◽

Cited By ~ 13

Author(s):

Qi Sun ◽

Jinyu Li ◽

Jiang Chen ◽

Chenying Zheng ◽

Chuyin Liu ◽

...

Keyword(s):

Blood Loss ◽

Randomised Controlled Trials ◽

Meta Analysis ◽

Total Blood Loss ◽

Controlled Trials ◽

Transfusion Rate ◽

Total Blood ◽

Total Knee ◽

Randomised Controlled ◽

Blood Loss Volume

ObjectiveThis study aimed to compare the effects of intravenous, topical and combined routes of tranexamic acid (TXA) administration on blood loss and transfusion requirements in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).DesignThis was a meta-analysis of randomised controlled trials (RCT) wherein the weighted mean difference (WMD) and relative risk (RR) were used for data synthesis applied in the random effects model. Stratified analyses based on the surgery type, region, intravenous and topical TXA dose and transfusion protocol were also conducted. The main outcomes included intraoperative and total blood loss volume, transfusion rate, low postoperative haemoglobin (Hb) level and postoperative Hb decline. However, the secondary outcomes included length of hospital stay (LOS) and/or occurrence of venous thromboembolism (VTE).SettingWe searched the PubMed, Embase and Cochrane CENTRAL databases for RCTs that compared different routes of TXA administration.ParticipantsPatients undergoing TKA or THA.InterventionsIntravenous, topical or combined intravenous and topical TXA.ResultsTwenty-six RCTs were selected, and the intravenous route did not differ substantially from the topical route with respect to the total blood loss volume (WMD=30.92, p=0.31), drain blood loss (WMD=−34.53, p=0.50), postoperative Hb levels (WMD=−0.01, p=0.96), Hb decline (WMD=−0.39, p=0.08), LOS (WMD=0.15, p=0.38), transfusion rate (RR=1.08, p=0.75) and VTE occurrence (RR=1.89, p=0.15). Compared with the combined-delivery group, the single-route group had significantly increased total blood loss volume (WMD=198.07, p<0.05), greater Hb decline (WMD=0.56, p<0.05) and higher transfusion rates (RR=2.51, p<0.05). However, no significant difference was noted in the drain blood loss, postoperative Hb levels and VTE events between the two groups. The intravenous and topical routes had comparable efficacy and safety profiles.ConclusionsThe combination of intravenous and topical TXA was relatively more effective in controlling bleeding without increased risk of VTE.

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Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02010-z ◽

2020 ◽

Vol 15 (1) ◽

Cited By ~ 1

Author(s):

Yimin Zhang ◽

Bao Lang ◽

Guifeng Zhao ◽

Fengming Wang

Keyword(s):

Total Knee Arthroplasty ◽

Blood Transfusion ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Meta Analysis ◽

Total Blood Loss ◽

Total Blood ◽

Study Results ◽

Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

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Effect of Tranexamic Acid after Cardiac Surgery in Children

Cardiovascular Journal ◽

10.3329/cardio.v1i2.8127 ◽

1970 ◽

Vol 1 (2) ◽

pp. 189-192

Author(s):

MK Hassan ◽

KA Hasan ◽

ABMA Salam ◽

A Razzak ◽

S Ferdous ◽

...

Keyword(s):

Cardiac Surgery ◽

Blood Loss ◽

Tranexamic Acid ◽

Pediatric Patients ◽

Acid Group ◽

Skin Incision ◽

Total Blood Loss ◽

Financial Cost ◽

Total Blood ◽

Transfusion Requirements

Background: The antifibrinolytic drug tranexamic acid (TA) decreases blood loss in Pediatric patients under going cardiac Surgery. However its efficacy has not been extensively studied in children. Method: We examined 750 children under going cardiac surgery form 2004 to 2007 in National Institute of Cardiovascular Diseases (NICVD), 379 children in the Tranexamic Acid group (TA) and 371 included in placebo (P) group. After induction of anesthesia and prior to skin incision, patients received either tranexamic acid (10mg/kg followed by 1mg/kg/hr) and saline placebo. After admission to intensive care unit total blood loss and transfusion requirements during the first12 hours were recorded. Result: Children who were treated with tranexamic acid had 24% less total blood loss (26±7 vs 34±17 ml/kg) compared with children who received placebo (p<0.05). Additionally, the total transfusion requirements, total donor unit exposure and financial cost of blood components were less in the tranexamic acid group. Conclusion: Tranexamic acid can reduce perioperative blood loss in children undergoing cardiac surgery.Keywords: Tranexemic acid; Cardiac surgery; Post operative; bleeding DOI: http://dx.doi.org/10.3329/cardio.v1i2.8127 Cardiovasc. j. 2009; 1(2) : 189-192

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