Szükség van szívódrénre elektív csípőprotézis-műtétek                     során?

Introduction: Several studies have been published which questioned the use of suction drain during elective hip arthroplasty. Aim: In this prospective study the authors examined how the use of suction drainage affected complications related to perioperative blood loss and hemorrhage in patients undergoing elective hip arthroplasty. Method: Eighty-six patients undergoing elective hip arthroplasty were divided into two groups. In 54 patients (“drain” group) suction drains were used during operation, whereas in 32 patients no suction drain was applied. Perioperative blood loss, use of tranexamic acid, method of thrombosis prophylaxis, transfusion requirement, incidental postoperative hemorrhage, septic complications, and all other postoperative complications were recorded. Results: Perioperative blood loss was affected with the use of tranexamic acid but not with the use of drainage (p = 0.94). Patients without the use of drain showed a tendency of lower transfusion requirement (p = 0.08). There was no correlation between any complications and the use of drainage. Conclusion: In accordance with published results the authors conclude that the routine use of suction drainage during elective hip arthroplasty is not definitely necessary. Orv. Hetil., 2016, 157(29), 1171–1176.

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Comparison of Oral and Intravenous Tranexamic Acid for Prevention of Perioperative Blood Loss in Total Knee and Total Hip Arthroplasty

Annals of Pharmacotherapy ◽

10.1177/1060028017735859 ◽

2017 ◽

Vol 52 (3) ◽

pp. 246-250 ◽

Cited By ~ 11

Author(s):

Mary Alice Gortemoller ◽

Bryan Allen ◽

Rochelle Forsyth ◽

Kimberly Theiss ◽

Kristal Cunningham ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Retrospective Chart Review ◽

Study Groups ◽

Total Hip ◽

Perioperative Blood Loss ◽

Total Knee ◽

Noninferiority Margin

Background: Tranexamic acid (TA) is an antifibrinolytic agent that prevents perioperative blood loss in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). This benefit has been established with the intravenous (IV) dosage form, but there is limited evidence evaluating oral TA in this setting. Objective: To compare the effect of oral versus IV TA on perioperative blood loss in those undergoing TKA or THA. Methods: In this single-centered retrospective chart review, participants at least 18 years of age who received IV or oral TA from a single surgeon who performed their THA or TKA were included. The primary outcome evaluated hemoglobin (Hgb) reduction. Power analysis determined that 165 participants were required in each group to achieve 80% power, with a noninferiority margin of 0.3 mg/dL. Results: Both study groups included 165 participants. Oral TA was noninferior to IV TA (Hgb difference = −0.12 g/dL [95% CI = −0.28 to 0.05; P = 0.0250]). A subgroup analysis of THA and TKA revealed that oral TA was noninferior to IV TA in THA (Hgb difference = 0.24 g/dL [95% CI = −0.17 to 0.5]), but oral TA failed to meet the noninferiority margin in the TKA subgroup (Hgb difference = −0.20 [95% CI = −0.38 to −0.02]). Conclusion: This study provides evidence that oral TA is a clinically effective and cost-efficient alternative to IV TA in the setting of THA and TKA.

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Efficiency of tranexamic acid in perioperative blood loss in hip arthroplasty: A systematic literature review and meta-analysis

Revista Española de Anestesiología y Reanimación (English Edition) ◽

10.1016/j.redare.2015.03.001 ◽

2015 ◽

Vol 62 (5) ◽

pp. 253-264

Author(s):

C.E. Pinzón-Florez ◽

K.M. Vélez Cañas ◽

D.M. Díaz Quijano

Keyword(s):

Literature Review ◽

Blood Loss ◽

Tranexamic Acid ◽

Systematic Literature Review ◽

Hip Arthroplasty ◽

Meta Analysis ◽

Perioperative Blood Loss

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Effect of carbazochrome sodium sulfonate combined with tranexamic acid on blood loss and inflammatory response in patients undergoing total hip arthroplasty

Bone and Joint Research ◽

10.1302/2046-3758.106.bjr-2020-0357.r2 ◽

2021 ◽

Vol 10 (6) ◽

pp. 354-362

Author(s):

Yue Luo ◽

Xin Zhao ◽

Zhouyuan Yang ◽

Releken Yeersheng ◽

Pengde Kang

Keyword(s):

Total Hip Arthroplasty ◽

Blood Loss ◽

Inflammatory Response ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Transfusion Rate ◽

Sodium Sulfonate ◽

Total Hip ◽

Perioperative Blood Loss ◽

Group D

Aims The purpose of this study was to examine the efficacy and safety of carbazochrome sodium sulfonate (CSS) combined with tranexamic acid (TXA) on blood loss and inflammatory responses after primary total hip arthroplasty (THA), and to investigate the influence of different administration methods of CSS on perioperative blood loss during THA. Methods This study is a randomized controlled trial involving 200 patients undergoing primary unilateral THA. A total of 200 patients treated with intravenous TXA were randomly assigned to group A (combined intravenous and topical CSS), group B (topical CSS), group C (intravenous CSS), or group D (placebo). Results Mean total blood loss (TBL) in groups A (605.0 ml (SD 235.9)), B (790.9 ml (SD 280.7)), and C (844.8 ml (SD 248.1)) were lower than in group D (1,064.9 ml (SD 318.3), p < 0.001). We also found that compared with group D, biomarker level of inflammation, transfusion rate, pain score, and hip range of motion at discharge in groups A, B, and C were significantly improved. There were no differences among the four groups in terms of intraoperative blood loss (IBL), intramuscular venous thrombosis (IMVT), and length of hospital stay (LOS). Conclusion The combined application of CSS and TXA is more effective than TXA alone in reducing perioperative blood loss and transfusion rates, inflammatory response, and postoperative hip pain, results in better early hip flexion following THA, and did not increase the associated venous thromboembolism (VTE) events. Intravenous combined with topical injection of CSS was superior to intravenous or topical injection of CSS alone in reducing perioperative blood loss. Cite this article: Bone Joint Res 2021;10(6):354–362.

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Tourniquet Application During Total Knee Arthroplasty Does Not Benefit Perioperative Blood Loss or Transfusion Requirement with the Routine Use of Tranexamic Acid

Reconstructive Review ◽

10.15438/rr.6.3.151 ◽

2016 ◽

Vol 6 (3) ◽

Author(s):

Tyler Steven Watters ◽

Daniel L Levy ◽

Raymond H Kim ◽

Todd M Miner ◽

Douglas A Dennis ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Blood Loss ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Transfusion Requirement ◽

Total Blood Loss ◽

Total Blood ◽

Perioperative Blood Loss ◽

Estimated Blood Loss ◽

Total Knee

AbstractBackground: The use of a tourniquet during total knee arthroplasty (TKA) continues to be a matter of debate. Advantages of tourniquet use include improved visualization, decreased intraoperative and total blood loss, and possibly decreased transfusion requirement. However, the recent widespread adoption of antifibrinolytic therapy with tranexamic acid (TXA), may negate these benefits. The purpose of this study was to evaluate perioperative blood loss and transfusion requirement with two different tourniquet application strategies, and surgery without the use of a tourniquet during routine, primary cemented TKA.Methods: A retrospective cohort study was performed of 300 patients undergoing TKA at a single institution after the implementation of a routine intravenous TXA administration protocol and consisted of three groups based on tourniquet usage: tourniquet inflation before incision and deflation following cement hardening (TQ), tourniquet inflation prior to cement application and deflation following hardening (Partial TQ), and no tourniquet usage (No TQ). Each group consisted of 100 consecutive patients. Perioperative blood loss, change in hematocrit and transfusion requirement were compared between groups. Results: Total blood loss (estimated blood loss and drain output) was lowest in the TQ group, however this was only due a slight decrease in intraoperative estimated blood loss. There was no difference in post-operative drain output, or change in hematocrit levels from preoperative values. There were no transfusions in the Partial TQ and No TQ groups, whereas there were 5 transfusions in the TQ group.Conclusions: In the era of routine TXA administration during TKA, tourniquet usage does not appear to have a benefit in regards to perioperative blood loss or transfusion requirement.

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Intravenous Tranexamic Acid Bolus plus Infusion Is Not More Effective than a Single Bolus in Primary Hip Arthroplasty

Anesthesiology ◽

10.1097/aln.0000000000001787 ◽

2017 ◽

Vol 127 (3) ◽

pp. 413-422 ◽

Cited By ~ 17

Author(s):

Keyword(s):

Blood Loss ◽

Tranexamic Acid ◽

Hip Arthroplasty ◽

Transfusion Trigger ◽

Erythrocyte Transfusion ◽

Restrictive Transfusion ◽

Infusion Group ◽

Perioperative Blood Loss ◽

Trigger Strategy ◽

Primary Hip Arthroplasty

Abstract Background Preoperative administration of the antifibrinolytic agent tranexamic acid reduces bleeding in patients undergoing hip arthroplasty. Increased fibrinolytic activity is maintained throughout the first day postoperation. The objective of the study was to determine whether additional perioperative administration of tranexamic acid would further reduce blood loss. Methods This prospective, double-blind, parallel-arm, randomized, superiority study was conducted in 168 patients undergoing unilateral primary hip arthroplasty. Patients received a preoperative intravenous bolus of 1 g of tranexamic acid followed by a continuous infusion of either tranexamic acid 1 g (bolus-plus-infusion group) or placebo (bolus group) for 8 h. The primary outcome was calculated perioperative blood loss up to day 5. Erythrocyte transfusion was implemented according to a restrictive transfusion trigger strategy. Results The mean perioperative blood loss was 919 ± 338 ml in the bolus-plus-infusion group (84 patients analyzed) and 888 ± 366 ml in the bolus group (83 patients analyzed); mean difference, 30 ml (95% CI, −77 to 137; P = 0.58). Within 6 weeks postsurgery, three patients in each group (3.6%) underwent erythrocyte transfusion and two patients in the bolus group experienced distal deep-vein thrombosis. A meta-analysis combining data from this study with those of five other trials showed no incremental efficacy of additional perioperative administration of tranexamic acid. Conclusions A preoperative bolus of tranexamic acid, associated with a restrictive transfusion trigger strategy, resulted in low erythrocyte transfusion rates in patients undergoing hip arthroplasty. Supplementary perioperative administration of tranexamic acid did not achieve any further reduction in blood loss.

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