Does Not Use of Closed Suction Drainage in Total Knee Arthroplasty with Tranexamic Acid Reduce Blood Loss?

2020 ◽  
Vol 22 (5) ◽  
pp. 343-352
Author(s):  
Naci Ruşen Senih Ayan ◽  
Yavuz Akalın ◽  
Nazan Çevik ◽  
Harun Sağlıcak ◽  
Burak Olcay Güler ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Total Knee ◽  
Group 2 ◽  
Group 1

Background. The aim of this study was to compare outcomes in patients who received intravenous tranexamic acid just before and after total knee arthroplasty with or without drains and to analyze whether there is any difference in terms of blood loss. Material and methods. This is a retrospective analysis of prospectively collected data of patients undergoing unilateral total knee arthroplasty. Between March 2017 and March 2019, 97 knees of 94 consecutive patients with osteoarthritis were divided into two groups (Group 1, with drain; and 2, without drain). Drainage group (53 knees; average age, 66,1±7,0 years; male, 10; female, 43) and a drainless group (44 knees; average age, 63,7± 7,5 years; male, 4; female, 40). All patients received systemic tranexamic acid (in 100 mL saline infusion iv in 30 minutes prior to the tourniquet inflation and 3 hours after the operation). Blood loss, allogeneic blood transfusion rates, complications such as swelling of the cruris, infection (deep or superficial), thromboembolic incidents (Deep venous thrombosis or pulmoner thromboembolism) and length of hospital stay were assessed postoperatively. Results. There was no difference in demographic parameters, body mass index, side ofsurgery, ASA score and anesthesia type between 2 groups. The preoperative Hb levels were comparable but on the postoperative day one, Hb level was lower in the drain group (p=0,017). Total blood loss (TBL) and allogeneic transfusion rates were lower in the drainless group, although did not differ significantly between the two groups [TBL: 1360,9±502,5 / 646,1-2641,6 (1251,6) mL in the Group 1, 1205,6±505,0 / 396,6-2521,0 (1157,5) mL in Group 2 (p=0,134); Transfusion rates: 11 out of 53 cases (%20,8) in group 1 and 5 out of 44 cases (%11,4) in group 2]. The infection rate and length of hospital stay were lower in the drainless group. But there were no statistical difference was found in terms of complications and length of hospital stay between 2 groups. Conclusions. 1. Performing Total Knee Arthroplasty with preoperative and postoperative ivtranexamic acid and without drain decreased postoperative reduction in Hb level on the day after surgery in the current study. 2. But blood loss and blood transfusion rates when compared to patients with drain, no significant difference was found. 3. Drain use in knee replacements does not offer an advantage over drainless TKAs regarding the findings of our study. 4. Future studies with longer follow-up are needed in our opinion.

scholarly journals Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

2021 ◽  
Vol 7 (2) ◽  
pp. 308
Author(s):  
Sanil G. Kamat ◽  
Rohan Dessai
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Blood Transfusions ◽  
Operative Outcomes ◽  
Total Knee ◽  
Retrospective Comparative Study ◽  
Group 1

<p class="abstract"><strong>Background: </strong>The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.</p><p class="abstract"><strong>Methods:</strong> Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.</p><p class="abstract"><strong>Results: </strong>It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.</p><p class="abstract"><strong>Conclusions: </strong>The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications.</p>

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

2020 ◽  
Vol 15 (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.

scholarly journals Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

2016 ◽  
Vol 28 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Young-Jun Seol ◽  
Jong-Keun Seon ◽  
Seung-Hun Lee ◽  
Cheng Jin ◽  
Jatin Prakash ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Knee

The Role of Knee Position in Blood Loss and Enhancement of Recovery after Total Knee Arthroplasty

2020 ◽  
Author(s):  
Le Cao ◽  
Haitao Yang ◽  
Kai Sun ◽  
Hanbang Wang ◽  
Haitao Fan ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Postoperative Blood Loss ◽  
Transfusion Rate ◽  
Analgesic Drugs ◽  
Extension Group ◽  
Total Knee

AbstractThe study aimed to investigate the effects of postoperative position of knee on blood loss and functional recovery after total knee arthroplasty (TKA). We enrolled patients who underwent TKA from 2017 to 2019 in our department with osteoarthritis of the knee in this prospective and randomized study. The patients were randomly allocated to flexion or extension group. In the flexion group, the affected leg was elevated by 30 degrees at the hip and the knee was flexed by 30-degree, postoperatively, while in the extension group, the affected knee was fully extended postoperatively. Patients' data related to postoperative blood loss, Hospital for Special Surgery scores, pain intensity, usage of analgesic drugs, circumference of knee, and range of motion (ROM) of knee were recorded to assess the influence of postoperative leg position on clinical outcomes. Although the transfusion rate was similar between the two groups (p > 0.05), other parameters related to blood loss (including total blood loss, hidden blood loss, usage of analgesic drugs, and postoperative circumference of knee) were significantly lower in the flexion group than those in the extension group (p < 0.05). After 6 weeks and 6 months of rehabilitation, patients gained a similar ROM in the affected knee in both groups (p > 0.05). The length of hospital stay and medical expenses were similar in both groups. Incidence of wound infection and other complications was also similar in both groups (p > 0.05). Elevation of the hip by knee flexion of 30 degrees is an effective and simple method to reduce blood loss after TKA, and contributes to reduction of the dosage of analgesic drugs in the early postoperative period. The routine application of the present protocol also did not increase medical costs and length of hospital stay after TKA.

Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty

2017 ◽  
Vol 31 (03) ◽  
pp. 270-276 ◽  
Author(s):  
Hernan Prieto ◽  
Heather Vincent ◽  
Justin Deen ◽  
Dane Iams ◽  
Hari Parvataneni
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Flexion Extension ◽  
Total Knee

AbstractTranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. Of these, 20 patients received TXA and 30 patients did not receive TXA and served as the control group. Primary outcome measurements were intraoperative estimated blood loss, hemoglobin (Hb) and Hematocrit (Hct) levels on postoperative day (POD) 1 and POD2, and blood transfusion rates. Secondary outcomes included length of stay (LOS), knee flexion/extension range of motion (ROM), and postoperative complications. There was no difference between groups for preoperative Hb and Hct (all p > 0.05). The TXA group demonstrate higher Hb levels at POD1 (11.7 in TXA vs. 10.4 controls; p < 0.001) and POD2 (10.5 in TXA vs. 9.6 controls; p < 0.001), as well as higher Hct levels at POD1 (35.6 in TXA vs. 32.1 controls; p < 0.001) and POD2 (31.9 in TXA vs. 29.3 controls; p < 0.001). There was less percentage variation in Hb levels in the TXA group from preoperative to POD1 (17.7% in TXA vs. 25.7% controls; p < 0.0001) and POD2 (26.1% TXA vs. 31.8% controls; p = 0.019). Similarly, less percentage variation in Hct levels in the TXA group from presurgery to POD1 (17.0% TXA vs. 25.7% controls; p < 0.0001) and POD2 (25.0% TXA vs. 31.3% controls; p = 0.005). A total of 23.3% of patients in the control group required transfusions compared with no patients in the TXA (p = 0.044). There were no differences in LOS, knee ROM, or number of complications. No thromboembolic events occurred. TXA in bilateral simultaneous TKA effectively reduces blood loss, maintains postoperative Hb and Hct levels, and significantly decreases blood transfusion rates. The level of evidence is level III (therapeutic study).

scholarly journals Blood Loss Control with Two Doses of Tranexamic Acid in a Multimodal Protocol for Total Knee Arthroplasty

2011 ◽  
Vol 5 (1) ◽  
pp. 44-48 ◽  
Author(s):  
Miguel Ortega-Andreu ◽  
Hanna Pérez-Chrzanowska ◽  
Reyes Figueredo ◽  
Enrique Gómez-Barrena
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Disease Transmission ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Postoperative Blood Transfusion ◽  
Transfusion Requirements ◽  
Total Knee

Average blood loss after total knee arthroplasty (TKA) usually ranges from 1500 to 1900 cc, including both the postoperative drain and hidden blood loss. This represents about 46% of TKA patients requiring postoperative blood transfusion. Not only the risks of disease transmission but also those of ABO incompatibility, infection due to immunosupression, increased procedure costs, and increased length of hospital stay, are potential problems that foster blood saving strategies. In this study, 71 unilateral TKAs using a multimodal protocol to decrease blood loss were compared to 61 historical cases. Patients in both groups underwent cemented TKA with the same system, surgical technique, and multimodal protocol (MIS approach, plug in the femoral canal, tourniquet removal after wound closure and compressive bandage, analgesic periarticular infiltration with vasoconstrictor, postoperative drain at atmospheric pressure, opened 2 hours after the end of the surgical procedure and removed after 24 hours). The study series incorporated intravenous tranexamic acid (TXA) infusion in 2 doses of 10-15 mg/kg, 15 minutes before tourniquet release and 3 hours later. Results showed no transfusion requirements in the TXA series (0%), with 23/61 (37.7%) transfusions in the control, with an average cost decrease of 240 euros per patient. Visible bleeding in 24h significantly decreased from 553.36 cc (range 50-1500) to 169.72 cc (range 10-480) in the TXA series. As a conclusion, implementing a TXA-based multimodal protocol produced significant decrease in the transfusion rate, visible blood loss, and cost per patient, thus proving effectiveness and efficiency in the surgical management of TKA.

scholarly journals Time to reconsider the routine use of tourniquets in total knee arthroplasty surgery

2021 ◽  
pp. 1-10
Author(s):  
Imran Ahmed ◽  
Amit Chawla ◽  
Martin Underwood ◽  
Andrew Price ◽  
Andrew Metcalfe ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Hospital Stay ◽  
Knee Arthroplasty ◽  
Length Of Hospital Stay ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Duration Of Surgery ◽  
Total Knee ◽  
The Mean

Aims Many surgeons choose to perform total knee arthroplasty (TKA) surgery with the aid of a tourniquet. A tourniquet is a device that fits around the leg and restricts blood flow to the limb. There is a need to understand whether tourniquets are safe, and if they benefit, or harm, patients. The aim of this study was to determine the benefits and harms of tourniquet use in TKA surgery. Methods We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled trials, and trial registries up to 26 March 2020. We included randomized controlled trials (RCTs), comparing TKA with a tourniquet versus without a tourniquet. Outcomes included: pain, function, serious adverse events (SAEs), blood loss, implant stability, duration of surgery, and length of hospital stay. Results We included 41 RCTs with 2,819 participants. SAEs were significantly more common in the tourniquet group (53/901 vs 26/898, tourniquet vs no tourniquet respectively) (risk ratio 1.73 (95% confidence interval (CI) 1.10 to 2.73). The mean pain score on the first postoperative day was 1.25 points higher (95% CI 0.32 to 2.19) in the tourniquet group. Overall blood loss did not differ between groups (mean difference 8.61 ml; 95% CI -83.76 to 100.97). The mean length of hospital stay was 0.34 days longer in the group that had surgery with a tourniquet (95% CI 0.03 to 0.64) and the mean duration of surgery was 3.7 minutes shorter (95% CI -5.53 to -1.87). Conclusion TKA with a tourniquet is associated with an increased risk of SAEs, pain, and a marginally longer hospital stay. The only finding in favour of tourniquet use was a shorter time in theatre. The results make it difficult to justify the routine use of a tourniquet in TKA surgery.

scholarly journals Tranexamic acid use in simultaneous bilateral total knee arthroplasty : a comparison of intravenous and intra-articular applications, which is more effective?

2021 ◽  
Vol 87 (3) ◽  
pp. 479-486
Author(s):  
Alpaslan Öztürk ◽  
Yavuz Akalin ◽  
Nazan Çevik ◽  
Özgür Avcı ◽  
Oğuz Çetin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Bilateral Total Knee Arthroplasty ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Total Knee

Patients applied with simultaneous bilateral total knee arthroplasty (SBTKA) with the administration of intravenous or intra-articular tranexamic acid (TXA) were compared in respect of blood loss and the need for allogenic blood transfusion. Of a total 53 patients applied with SBTKA, 32(60%) were administered intravenous TXA and 21(40%) intra-articular TXA. The patients were evaluated in respect of age, gender, height, weight, body mass index (BMI), body blood volume, preoperative and 1,2,3 and 4 days postoperative levels of hemoglobin (Hb) and hematocrit (Htc) and the change in Hb levels, estimated blood loss, mean actual blood loss, the need for allogenic blood transfusion (ABT) and the use or not of a drain. No difference was determined between the intravenous and intra-articular groups in respect of mean age, gender, height, weight, and body blood volume. No difference was determined between the groups in preoperative and postoperative mean Hb and Hct values, the reduction in mean Hb postoperatively, estimated blood loss, or the need for ABT. No deep vein thrombosis or pulmonary embolism was determined in any patient. In the application of SBTKA, TXA can be safely administered by the intravenous or intra-articular route to reduce the need for ABT. The results of this study determined no difference in efficacy between the routes of application. For patients with a risk of intravenous use, intra-articular application can be preferred.

scholarly journals A study of efficacy of tranexamic acid in reduction of blood loss in primary total knee arthroplasty

2018 ◽  
Vol 4 (2) ◽  
pp. 309
Author(s):  
B. Hari Krishnan ◽  
Akshay Pushkar ◽  
Rohit Vikas
Keyword(s):  
Total Knee Arthroplasty ◽  
Placebo Group ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Fisher Exact Test ◽  
Increased Risk ◽  
Total Knee ◽  
Primary Total Knee

<p class="abstract"><strong>Background:</strong> Tranexamic acid (<span lang="EN-GB">TXA</span>) has been shown to be effective in reducing blood loss during trauma and surgeries. Although there is no well-established protocol, it is now increasingly being used in joint replacement surgeries. The present study was designed to study the effect of intravenously given tranexamic acid during primary total knee replacement in reducing intraoperative blood loss and need for blood transfusion requirement, compared to a placebo<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-GB">This study was designed as a parallel arm, double blind trial. 100 patients of primary osteoarthritis undergoing total knee arthroplasty under tourniquet was included in the study. The efficacy of a single preoperative bolus of TXA in the dose of 15 mg/kg on perioperative blood losses was studied against a placebo with objectives to compare the pre- and 24-hours post-operative level of haemoglobin (Hb) and haematocrit (Hct) levels and assess total volume of blood loss till 24-hours postoperatively and need for blood transfusion</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-GB">Out of 168 patients, who underwent TKA in our centre during the period of the study, 100 were included in the study, 50 patients were included in placebo group and 50 patients were included in TXA group. There was a statistically significant reduction in the use of transfusion (Fisher exact test; P=0.001). A total of 46 units of blood were used; 42 units transfused to participants in the placebo group and only 4 units transfused to participants in the TXA group</span><span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-GB">Intravenous TXA in primary arthroplasty leads to a statistically significant reduction in total blood loss and requirement for allogeneic blood transfusion with no apparent increased risk of thrombo-embolic complications</span><span lang="EN-IN">.</span></p>

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