Evaluation of the efficacy of intra-articular tranexamic acid in patients with hypertension undergoing simultaneous bilateral total knee arthroplasty
Abstract
ABSTRACT
Background: The relationship between hypertension (HT) and increased perioperative
transfusion rate in patients who underwent total knee arthroplasty (TKA) was
previously investigated in the literature. This phenomenon may also increase
the need for blood transfusion in patients who underwent bilateral simultaneous
TKA despite using tranexamic acid (TXA). The main purpose of this study was to evaluate
the decrease in hemoglobin levels and need for blood transfusion in patients
with the diagnosis of HT who underwent bilateral simultaneous TKA after
intra-articular (IA) administration of TXA in comparison to those who did not
receive TXA.
Methods: One hundred and ninety-one patients with the diagnosis of HT who
underwent bilateral simultaneous TKA and fulfilled the criteria, were evaluated
in this retrospective study. Patients were grouped as TXA group (individuals
who received IA TXA) and control group (did not receive TXA). Primary outcome
measures were decrease in hemoglobin levels and number of blood units
transfused.
Results: Both groups were similar
in age, gender, body mass index and American Society of Anesthesiologist (ASA) score
and no statistically significant differences were observed. There was also no
statistically significant difference between groups in terms of decrease in
hemoglobin levels (P=0.844) and number
of blood units transfused (P=0.095).
Conclusion: According to our results, in patients with the
diagnosis of HT undergoing simultaneous bilateral TKA procedure, no significant
difference was observed in the decrease of hemoglobin level and number of blood
units transfused between patients who received IA TXA in comparison to those who
did not receive TXA.
Keywords: tranexamic acid; hypertension; total knee arthroplasty; blood loss;
blood transfusion; hemoglobin level
References
- 1. Parvizi J, Chaudhry S, Rasouli MR, et al. Who needs autologous blood donation in joint replacement? J Knee Surg 2011;24(01):25–31
- 2. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81(01):2–10
- 3. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg A 2003;85-A;(10):1981–1986
- 4. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S. One stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 1994;(309):94–101
- 5. Ponnusamy KE, Kim TJ, Khanuja HS. Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am 2014;96(21): 1836
- 6. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014;22:361-71.
- 7. Wang J, Wang Q, Zhang X, Wang Q. Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty. 2017;32(11):3385-3389
- 8. Yang Z G, Chen W P, Wu L D. Effectiveness and safety of 323 tranexamic acid in 324 reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012;94(13): 1153-1159.
- 9. Springer BD, Odum SM, Fehring TK. What Is the Benefit of Tranexamic Acid vs Reinfusion Drains in Total Joint Arthroplasty? J Arthroplasty 2016;31(1):76-80.
- 10. Prieto HA, Vincent HK, Deen JT, Iams DA, Parvataneni HK. Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg. 2017 May 15. doi:10.1055/s-0037-1603333. [Epub ahead of print
- 11. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57(06):1005–1032
- 12. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 2014; 29(8): 1528-31.
- 13. Chimento GF, Huff T, Ochsner JL , Jr, Meyer M, Brandner L, Babin S. An evaluation of the use of topical tranexamic acid in total knee arthroplasty. J Arthroplasty 2013; 28: 74-7.
- 14. Durasek J, Dovzak-Bajs I, Sarić V. [Factors affecting blood loss in total knee arthroplasty patients]. Acta Med Croatica 2010;64(3):209-14. Croatian.
- 15. Kulej M, Dragan S, Płocieniak K, Krawczyk A, Dragan SŁ, Baryła-Urban P. Evaluation of blood loss and significance of postoperative autotransfusion in knee joint alloplasty. Ortop Traumatol Rehabil 2012;14(1):31-40. English, Polish.
- 16. Borghi B, Oriani G, Bassi A. Blood saving program: a multicenter Italian experience. Int J Artif Organs 1995;18(3):150-8.
- 17. Russo RR, Dasa V, Duarte R, Beakley B, Mishra M, Thompson H. Post-operative hypertension after total knee arthroplasty and the effects on transfusion rates. PLoS One 2012;7(12):e50967.
- 18. Chen X, Cao X, Yang C, Guo K, Zhu Q, Zhu J. Effectiveness and Safety of Fixed-Dose Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Double-Blind Controlled Trial. J Arthroplasty 2016;31(11):2471-2475.
- 19. Zhu M, Chen JY, Yew AK, Chia SL, Lo NN, Yeo SJ. Intra-articular tranexamic acid wash during bilateral total knee arthroplasty. J Orthop Surg (Hong Kong) 2015;23(3):290-3.
- 20. Aggarwal AK, Singh N, Sudesh P. Topical vs Intravenous Tranexamic Acid in Reducing Blood Loss After Bilateral Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2016;31(7):1442-8.
- 21. Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V. Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 2013;28(10):1888-91.
- 22. Bell TH, Berta D, Ralley F, Macdonald SJ, McCalden RW, Bourne RB, Rorabeck CH, Naudie DD. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1642 patients. Can J Surg 2009;52(4):295-301
- 23. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 2004;19(3):281-7.
- 24. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011;26(1):24-8.
- 25. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004;86-A(1):57-61.
- 26. Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogenic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care 2003;31:529.
- 27. Barrett J, Baron JA, Losina E, et al. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg (Am) 2006;88:2146.
- 28. Pookaranjanamorakot C, Sirisriro R, Eurvilaichit C, et al.The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography. J Med Assoc Thai 2004;87:869.
- 29. Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2007;89(06):1220–1226
Eşzamanlı bilateral total diz artroplastisi uygulanan hipertansiyonlu hastalarda intra-artiküler tranexamik asit etkinliğinin değerlendirilmesi
Abstract
ÖZET
Amaç: Total diz artroplastisi (TDA) uygulanan
hastalarda hipertansiyon (HT) ile artmış perioperatif transfüzyon oranı
arasındaki ilişki literatürde daha önce araştırılmıştır. Bu durum aynı zamanda
traneksamik asit (TXA) kullanmasına rağmen eşzamanlı bilateral TKA uygulanan
hastalarda kan nakli ihtiyacını da artırabilir. Bu çalışmanın temel amacı,
TXA'nın intraartiküler (İA) uygulanmasından sonra eşzamanlı bilateral TDA
yapılan HT tanılı hastalarda, TXA almayanlara kıyasla, hemoglobin düzeylerinde
azalma ve kan transfüzyonu ihtiyacını değerlendirmektir .
Yöntem: Bu retrospektif çalışmada, eşzamanlı
bilateral TDA uygulanan ve kriterlere uyan HT tanılı 191 hasta değerlendirildi.
Hastalar TXA grubu (IA TXA alanlar) ve kontrol grubu (TXA almayanlar) olarak
gruplandırıldı. Temel sonuç olarak belirleyiciler, hemoglobin düzeyleri ve kan
transfüzyonu ünite sayısında azalma idi.
Bulgular: Her iki grup yaş, cinsiyet, vücut kitle
indeksi ve Amerikan Anesteziyoloji Derneği (ASA) skoru bakımından benzerdi ve
istatistiksel olarak anlamlı bir farklılık gözlenmedi. Hemoglobin düzeylerinde
(P = 0.844) azalma ve kan transfüzyonu ünite sayısı (P = 0.095) açısından
gruplar arasında istatistiksel olarak anlamlı fark yoktu.
Sonuç: Bulgularımıza göre, eşzamanlı bilateral
TKA prosedürü uygulanan HT tanılı hastalarda, IA TXA alan ve almayan hastalar
arasında hemoglobin seviyesinin azalması ve kan transfüzyonu ünite sayısı arasında
istatistiksel olarak anlamlı fark bulunamamıştır.
Anahtar Kelimeler: traneksamik asit; hipertansiyon; total
diz artroplastisi; kan kaybı; kan nakli; hemoglobin seviyesi
Keywords
traneksamik asit; hipertansiyon; total diz artroplastisi; kan kaybı; kan nakli; hemoglobin seviyesi
References
- 1. Parvizi J, Chaudhry S, Rasouli MR, et al. Who needs autologous blood donation in joint replacement? J Knee Surg 2011;24(01):25–31
- 2. Bierbaum BE, Callaghan JJ, Galante JO, Rubash HE, Tooms RE, Welch RB. An analysis of blood management in patients having a total hip or knee arthroplasty. J Bone Joint Surg Am 1999;81(01):2–10
- 3. Bullock DP, Sporer SM, Shirreffs TG Jr. Comparison of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg A 2003;85-A;(10):1981–1986
- 4. Jankiewicz JJ, Sculco TP, Ranawat CS, Behr C, Tarrentino S. One stage versus 2-stage bilateral total knee arthroplasty. Clin Orthop Relat Res 1994;(309):94–101
- 5. Ponnusamy KE, Kim TJ, Khanuja HS. Perioperative blood transfusions in orthopaedic surgery. J Bone Joint Surg Am 2014;96(21): 1836
- 6. Levine BR, Haughom B, Strong B, Hellman M, Frank RM. Blood management strategies for total knee arthroplasty. J Am Acad Orthop Surg. 2014;22:361-71.
- 7. Wang J, Wang Q, Zhang X, Wang Q. Intra-articular Application is More Effective Than Intravenous Application of Tranexamic Acid in Total Knee Arthroplasty: A Prospective Randomized Controlled Trial. J Arthroplasty. 2017;32(11):3385-3389
- 8. Yang Z G, Chen W P, Wu L D. Effectiveness and safety of 323 tranexamic acid in 324 reducing blood loss in total knee arthroplasty: a meta-analysis. J Bone Joint Surg Am 2012;94(13): 1153-1159.
- 9. Springer BD, Odum SM, Fehring TK. What Is the Benefit of Tranexamic Acid vs Reinfusion Drains in Total Joint Arthroplasty? J Arthroplasty 2016;31(1):76-80.
- 10. Prieto HA, Vincent HK, Deen JT, Iams DA, Parvataneni HK. Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty. J Knee Surg. 2017 May 15. doi:10.1055/s-0037-1603333. [Epub ahead of print
- 11. Dunn CJ, Goa KL. Tranexamic acid: a review of its use in surgery and other indications. Drugs 1999;57(06):1005–1032
- 12. Patel JN, Spanyer JM, Smith LS, Huang J, Yakkanti MR, Malkani AL. Comparison of intravenous versus topical tranexamic acid in total knee arthroplasty: a prospective randomized study. J Arthroplasty 2014; 29(8): 1528-31.
- 13. Chimento GF, Huff T, Ochsner JL , Jr, Meyer M, Brandner L, Babin S. An evaluation of the use of topical tranexamic acid in total knee arthroplasty. J Arthroplasty 2013; 28: 74-7.
- 14. Durasek J, Dovzak-Bajs I, Sarić V. [Factors affecting blood loss in total knee arthroplasty patients]. Acta Med Croatica 2010;64(3):209-14. Croatian.
- 15. Kulej M, Dragan S, Płocieniak K, Krawczyk A, Dragan SŁ, Baryła-Urban P. Evaluation of blood loss and significance of postoperative autotransfusion in knee joint alloplasty. Ortop Traumatol Rehabil 2012;14(1):31-40. English, Polish.
- 16. Borghi B, Oriani G, Bassi A. Blood saving program: a multicenter Italian experience. Int J Artif Organs 1995;18(3):150-8.
- 17. Russo RR, Dasa V, Duarte R, Beakley B, Mishra M, Thompson H. Post-operative hypertension after total knee arthroplasty and the effects on transfusion rates. PLoS One 2012;7(12):e50967.
- 18. Chen X, Cao X, Yang C, Guo K, Zhu Q, Zhu J. Effectiveness and Safety of Fixed-Dose Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty: A Randomized Double-Blind Controlled Trial. J Arthroplasty 2016;31(11):2471-2475.
- 19. Zhu M, Chen JY, Yew AK, Chia SL, Lo NN, Yeo SJ. Intra-articular tranexamic acid wash during bilateral total knee arthroplasty. J Orthop Surg (Hong Kong) 2015;23(3):290-3.
- 20. Aggarwal AK, Singh N, Sudesh P. Topical vs Intravenous Tranexamic Acid in Reducing Blood Loss After Bilateral Total Knee Arthroplasty: A Prospective Study. J Arthroplasty 2016;31(7):1442-8.
- 21. Hegde C, Wasnik S, Kulkarni S, Pradhan S, Shetty V. Simultaneous bilateral computer assisted total knee arthroplasty: the effect of intravenous or intraarticular tranexamic acid. J Arthroplasty 2013;28(10):1888-91.
- 22. Bell TH, Berta D, Ralley F, Macdonald SJ, McCalden RW, Bourne RB, Rorabeck CH, Naudie DD. Factors affecting perioperative blood loss and transfusion rates in primary total joint arthroplasty: a prospective analysis of 1642 patients. Can J Surg 2009;52(4):295-301
- 23. Bong MR, Patel V, Chang E, Issack PS, Hebert R, Di Cesare PE. Risks associated with blood transfusion after total knee arthroplasty. J Arthroplasty 2004;19(3):281-7.
- 24. MacGillivray RG, Tarabichi SB, Hawari MF, Raoof NT. Tranexamic acid to reduce blood loss after bilateral total knee arthroplasty: a prospective, randomized double blind study. J Arthroplasty 2011;26(1):24-8.
- 25. Pola E, Papaleo P, Santoliquido A, Gasparini G, Aulisa L, De Santis E. Clinical factors associated with an increased risk of perioperative blood transfusion in nonanemic patients undergoing total hip arthroplasty. J Bone Joint Surg Am 2004;86-A(1):57-61.
- 26. Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogenic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care 2003;31:529.
- 27. Barrett J, Baron JA, Losina E, et al. Bilateral total knee replacement: staging and pulmonary embolism. J Bone Joint Surg (Am) 2006;88:2146.
- 28. Pookaranjanamorakot C, Sirisriro R, Eurvilaichit C, et al.The incidence of deep vein thrombosis and pulmonary embolism after total knee arthroplasty: the screening study by radionuclide venography. J Med Assoc Thai 2004;87:869.
- 29. Restrepo C, Parvizi J, Dietrich T, Einhorn TA. Safety of simultaneous bilateral total knee arthroplasty. A meta-analysis. J Bone Joint Surg Am 2007;89(06):1220–1226
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Surgical Science Research Articles |
| Authors | |
| Publication Date | June 5, 2018 |
| Acceptance Date | April 6, 2018 |
| Published in Issue | Year 2018 |