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Journal Information
Vol. 60. Issue 5.
Pages 315-324 (September - October 2016)
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Vol. 60. Issue 5.
Pages 315-324 (September - October 2016)
Original Article
DOI: 10.1016/j.recote.2016.07.003
Efficacy of 2 grammes of intravenous transexamic acid in the reduction of post-surgical bleeding after total hip and knee replacement
Eficacia de 2 gramos intravenosos de ácido tranexámico en la reducción del sangrado postoperatorio de la artroplastia total de cadera y rodilla
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M. Castro-Menéndeza,
Corresponding author
, S. Pena-Pazb, F. Rocha-Garcíac, N. Rodríguez-Casasa, R. Huici-Izcoa, A. Montero-Viéitesa
a Servicio de Cirugía Ortopédica y Traumatología, Hospital de Monforte de Lemos, Lugo, Spain
b Servicio de Cirugía Ortopédica y Traumatología, Hospital Lucus Augusta, Lugo, Spain
c Servicio de Anestesia y Reanimación, Hospital de Monforte de Lemos, Lugo, Spain
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Tables (6)
Table 1. Estimated volume of blood in adults according to Gilcher's criteria.
Table 2. Description of the sample.
Table 3. Average figures (±standard deviation) for preoperative haemoglobin, postoperative haemoglobin; average fall in haemoglobin; preoperative hematocrit, postoperative hematocrit; average fall in hematocrit and estimated blood loss, divided according to groups and type of surgery (THR and TKR).
Table 4. The relationship between the average fall in Hb and Ht and the TXA administration regime (groups 1, 2 and 3) in total knee arthroplasty.
Table 5. The relationship between the average fall in Hb and Ht and the TXA administration regime (groups 1, 2 and 3) in total hip arthroplasty.
Table 6. The relationship between the dose of TXA and the percentage of transfusion (sample total and divided into TKR and THR).
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Abstract
Background

There is currently sufficient clinical evidence to recommend tranexamic acid (TXA) for reducing post-operative blood loss in total knee and hip arthroplasty, however, its optimal dose and administration regimes are unknown.

Objective

Analyse effectiveness and safety of TXA in total hip and knee arthroplasty using 2 grammes (g) intravenously in two different regimes.

Material and methods

A prospective randomised intervention study was conducted on a total of 240 patients. The patients were divided into 3 groups: (1) control; (2) 1g of TXA intraoperative, followed by another postoperative; and (3) 2g preoperative. Each group consisted of 40 patients undergoing total knee arthroplasty, and 40 total hip arthroplasty.

Postoperative blood loss, transfusion rate, and thromboembolic complications were studied.

Results

There were significant differences (P<.005) when comparing mean total blood loss and transfusion between group 1 and 2, and between group 1 and 3, but not between the two TXA groups (2 and 3). The authors only recorded one complication in group 1 (deep vein thrombosis).

Discusion

This study was not performed to investigate the already well established effectiveness of TXA, but to confirm if 2 empirical intravenous g is safe, and what is most beneficial regimen.

In conclusion, according to the literature, both proven patterns of 2g intravenous of TXA are effective in reducing blood loss and transfusion requirements, without increasing the complication rate.

Keywords:
Tranexamic acid
Blood loss
Transfusion
Thromboembolic complications
Resumen
Introducción

Actualmente, para disminuir el sangrado postoperatorio en la cirugía de artroplastia de cadera y rodilla, hay suficiente evidencia científica para recomendar el uso del ácido tranexámico (ATX), sin embargo, la dosis y pauta ideal para obtener su máximo beneficio es desconocida.

Objetivo

Analizar la efectividad y seguridad del uso del ATX en cirugía de artroplastia de cadera y rodilla a dosis fijas de 2 gramos (g) intravenosos con dos pautas diferentes.

Material y métodos

Se realiza un estudio de intervención prospectivo aleatorizado de 240 pacientes. Los pacientes fueron divididos en 3 grupos: 1) control; 2) administración de 1g de ATX intraoperatorio y otro postoperatorio; 3): 2g de ATX preoperatorios. Cada grupo consta de 40 pacientes intervenidos de artroplastia total de rodilla y otros 40 de cadera.

Se estudia la pérdida sanguínea postoperatoria, índice de transfusiones y la aparición de complicaciones tromboembólicas.

Resultados

Se obtienen diferencias estadísticamente significativas (p<0,05) en la pérdida sanguínea y transfusión entre grupo 1 y grupos 2 y 3, pero no entre grupos 2 y 3. Observamos una complicación en grupo 1 (trombosis venosa profunda).

Discusión

Se realizó este estudio no para confirmar la eficacia del ATX, un hecho ya establecido, si no para confirmar si la pauta empírica de 2 g iv. es segura y qué pauta es más beneficiosa.

En conclusión podemos decir, coincidiendo con la literatura, que ambas pautas probadas de ATX son efectivas en la reducción de pérdida sanguínea y en las necesidades de transfusión sin aumentar el índice de complicaciones.

Palabras clave:
Ácido tranexámico
Sangrado
Transfusión
Complicaciones tromboembólicas

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