PURPOSE: Despite the documented blood-saving effects of tranexamic acid (TNA) in total knee arthroplasty (TKA), the question whether clinical values of TNA are identical in unilateral and bilateral TKAs remains unclear. This study was undertaken to determine the clinical values of TNA in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol in terms of efficacy (total blood loss and transfusion rate) and safety (the incidences of symptomatic deep vein thrombosis and pulmonary embolism). METHODS:One hundred and eighty unilateral and 146 bilateral TKA patients were randomized into TNA group or control group. In unilateral TKA patients, TNA (10 mg/kg) was administered intravenously 20 min before tourniquet deflation and repeated 3 h after surgery. In bilateral TKA patients, one more dose (10 mg/kg) was given before tourniquet deflation in the second TKA. A contemporary blood-saving protocol was applied to all patients. The TNA and control groups were compared separately in unilateral and bilateral TKA patients for the efficacy and safety variables. RESULTS: In unilateral TKA patients, the TNA group had less total blood loss (905 vs. 1,018 mL, p = 0.018) than the control group, but there was no difference in the allogenic transfusion rate (1 vs. 7 %, n.s.). In bilateral TKA patients, the TNA group showed no differences in total blood loss (1,282 vs. 1,379 mL, n.s.), but a significant reduction in the allogenic transfusion rate (7 vs. 27 %, p = 0.002). No symptomatic deep vein thrombosis or pulmonary embolism was found in all patients. CONCLUSION: This study demonstrates that the use of TNA reduces total blood loss, but the effects on the transfusion rate can differ depending on the type of TKAs (unilateral vs. bilateral) and the blood-saving protocols.
RCT Entities:
PURPOSE: Despite the documented blood-saving effects of tranexamic acid (TNA) in total knee arthroplasty (TKA), the question whether clinical values of TNA are identical in unilateral and bilateral TKAs remains unclear. This study was undertaken to determine the clinical values of TNA in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol in terms of efficacy (total blood loss and transfusion rate) and safety (the incidences of symptomatic deep vein thrombosis and pulmonary embolism). METHODS: One hundred and eighty unilateral and 146 bilateral TKA patients were randomized into TNA group or control group. In unilateral TKA patients, TNA (10 mg/kg) was administered intravenously 20 min before tourniquet deflation and repeated 3 h after surgery. In bilateral TKA patients, one more dose (10 mg/kg) was given before tourniquet deflation in the second TKA. A contemporary blood-saving protocol was applied to all patients. The TNA and control groups were compared separately in unilateral and bilateral TKA patients for the efficacy and safety variables. RESULTS: In unilateral TKA patients, the TNA group had less total blood loss (905 vs. 1,018 mL, p = 0.018) than the control group, but there was no difference in the allogenic transfusion rate (1 vs. 7 %, n.s.). In bilateral TKA patients, the TNA group showed no differences in total blood loss (1,282 vs. 1,379 mL, n.s.), but a significant reduction in the allogenic transfusion rate (7 vs. 27 %, p = 0.002). No symptomatic deep vein thrombosis or pulmonary embolism was found in all patients. CONCLUSION: This study demonstrates that the use of TNA reduces total blood loss, but the effects on the transfusion rate can differ depending on the type of TKAs (unilateral vs. bilateral) and the blood-saving protocols.
Authors: Juan C Alvarez; Francisco X Santiveri; Isabel Ramos; Enrique Vela; Lluis Puig; Fernando Escolano Journal: Transfusion Date: 2007-12-07 Impact factor: 3.157
Authors: Norman A Johanson; Paul F Lachiewicz; Jay R Lieberman; Paul A Lotke; Javad Parvizi; Vincent Pellegrini; Theodore A Stringer; Paul Tornetta; Robert H Haralson; William C Watters Journal: J Am Acad Orthop Surg Date: 2009-03 Impact factor: 3.020
Authors: Matthew R Bong; Vipul Patel; Eric Chang; Paul S Issack; Rudi Hebert; Paul E Di Cesare Journal: J Arthroplasty Date: 2004-04 Impact factor: 4.757
Authors: Sergio Romagnoli; Sara Zacchetti; Paolo Perazzo; Francesco Verde; Giuseppe Banfi; Marco Viganò Journal: Int Orthop Date: 2013-07-24 Impact factor: 3.075
Authors: Sara Moráis; Miguel Ortega-Andreu; Emerito Carlos Rodríguez-Merchán; Norma G Padilla-Eguiluz; Hanna Pérez-Chrzanowska; Reyes Figueredo-Zalve; Enrique Gómez-Barrena Journal: Int Orthop Date: 2013-12-07 Impact factor: 3.075
Authors: Vasileios Soranoglou; Lazaros A Poultsides; Georgios K Triantafyllopoulos; Ivan De Martino; Stavros G Memtsoudis; Thomas P Sculco Journal: HSS J Date: 2017-12-07