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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Clinical trial on the effect of tranexamic acid on bleeding and fibrinolysis in ...
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Vol. 66. Issue 6.
Pages 299-306 (June - July 2019)
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Vol. 66. Issue 6.
Pages 299-306 (June - July 2019)
Original article
Clinical trial on the effect of tranexamic acid on bleeding and fibrinolysis in primary hip and knee replacement
Ensayo clínico sobre el efecto del ácido tranexámico en el sangrado y la fibrinólisis durante la artroplastia simple de cadera y rodilla
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J. Alvareza,
Corresponding author
94188@hospitaldelmar.cat

Corresponding author.
, F.J. Santiveria, M.I. Ramosa, L. Gallarta, L. Aguileraa, L. Puig-Verdieb
a Servicio de Anestesia Reanimación y Terapia del Dolor, Parc de Salut MAR, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
b Servicio de Cirugía Ortopédica y Traumatología, Parc de Salut MAR, Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
Article information
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Figures (1)
Tables (4)
Table 1. Patient demographics and preoperative characteristics.
Table 2. Intraoperative variables.
Table 3. Relevant clinical data.
Table 4. The effect of surgery and arthroplasty on the parameters of coagulation and fibrinolysis.
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Abstract
Background

Tourniquet-induced ischaemia could increase fibrinolysis and enhance tranexamic acid (TXA) efficacy in total knee arthroplasty (TKA) compared to total hip arthroplasty (THA). The aims of this study are to compare the effect of TXA on bleeding and fibrinolysis in both types of surgery, and to record thromboembolic complications.

Methods

A prospective double-blind study was conducted on patients scheduled for TKA or THA who received TXA (2 bolus of 10mg/kg) or placebo. Bleeding and fibrinolysis were evaluated. Doppler-ultrasound and computed tomography were performed in order to assess any thromboembolic complications.

Results

A total of 44 patients were included (11 THA and 11 TKA treated with TXA; 11 THA and 11 TKA as controls). Blood losses were significantly lower in the TXA group (mean 921mL vs 1383mL in THA and 969mL vs 1223mL in TKA), and no transfusions were needed with TXA, whereas 5 blood units were transfused in controls. TXA was equally effecting in reducing bleeding in both surgeries (33% in THA and 21% in TKA). The significant mean increase in d-dimers from baseline to 6h after surgery (1004μg/L to 10,284μg/L in THA and 571μg/L to 6480μg/L in TKA) was attenuated by TXA (1077μg/L to 2590μg/L in THA and 655μg/L to 2535μg/L in TKA). There were no differences in thromboembolic episodes.

Conclusions

Prophylactic use of tranexamic acid is equally effective in reducing bleeding in TKA and THA. Both surgeries have a similar effect on fibrinolysis.

Keywords:
Blood-loss
Blood-transfusion
Blood-coagulation
Thrombosis
Knee replacement
Hip replacement
Resumen
Objetivo

La isquemia derivada de la aplicación del torniquete es un factor fibrinolítico que podría potenciar la eficacia del ácido tranexámico (ATx) en artroplastia total de rodilla (ATR) frente a la artroplastia total de cadera (ATC). Nuestro objetivo es comparar el efecto del ATx sobre sangrado y fibrinólisis en estas 2 artroplastias, valorando la incidencia de complicaciones.

Método

Ensayo clínico prospectivo, aleatorizado y doble ciego. Los pacientes programados para ATR o ATC recibían ATx (2 infusiones 10mg/kg) o placebo. Se cuantificó sangrado y parámetros de fibrinólisis, y se detectaron complicaciones tromboembólicas con ecografía doppler y tomografía computarizada.

Resultados

Fueron incluidos 44 pacientes (11 ATC y 11 ATR tratados con ATx; 11 ATC y 11 ATR fueron controles). El sangrado fue significativamente menor en el grupo tratado con ATx (promedio 921mL vs. 1383mL en ATC y 969mL vs. 1223mL en ATR) y se necesitaron menos transfusiones (ninguna frente a 5 unidades en grupo control). El ATx fue igualmente eficaz en la reducción del sangrado en ambas cirugías (reducción del 33% en ATC y del 21% en ATR). El gran incremento medio de dímero D entre el periodo basal y las 6h (1.004 a 10.284μg/L en ATC y 571 a 6.480μg/L en ATR) es atenuado por el uso de ATx (1.077 a 2.590μg/L en ATC y 655 a 2.535μg/L en ATR). No hubo diferencias significativas en eventos tromboembólicos.

Conclusiones

El ATx profiláctico es igualmente efectivo en ATR y ATC para reducir sangrado. Ambas cirugías tienen efecto similar sobre la fibrinólisis.

Palabras clave:
Sangrado
Transfusión sanguínea
Coagulación
Trombosis
Artroplastia de cadera
Artroplastia de rodilla

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