Yiting Lei1, Jinwei Xie1, Bin Xu1, Xiaowei Xie1, Qiang Huang1, Fuxing Pei2. 1. Department of Orthopaedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China. 2. Department of Orthopaedics, West China Hospital, Sichuan University, 37# WainanGuoxue Road, Chengdu, 610041, People's Republic of China. peifux@126.com.
Abstract
PURPOSE: To assess the efficacy and safety of multiple-dose intravenous tranexamic acid (IV-TXA) on blood loss following total knee arthroplasty (TKA). METHODS:One hundred fifty nine patients receivedone bolus of IV-TXA before skin incision and two boluses three and six hours later (group A), or another bolus nine hours later (group B), or another two boluses nine and 12 hours later (group C). The primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum haemoglobin (Hb) drop. Other outcome measurements such as fibrinolysis parameters [fibrin(-ogen) degradation products (FDP), D-dimer], inflammatory factors [interleukin-6 (IL-6)], transfusion rate, range of motion (ROM), length of hospital stay (LOH), and complications were also recorded and compared. RESULTS: The mean TBL, HBL and maximum Hb drop in group C (p < 0.001, p < 0.001, p = 0.025) and group B (p = 0.025, p = 0.025, p = 0.044) were lower than those in group A. FDP and D-Dimer in group C was lower than in group A and B on post-operative day one. IL-6 in group A, B and C showed a downward tendency on post-operative days one and three (POD1 and POD3). Moreover, the ROM and LOH were better in group C. No episodes of transfusion or deep venous thrombosis (DVT) were detected in all groups. CONCLUSIONS: The 5-dose TXA regimen can further reduce the blood loss, diminish the maximum Hb drop, minimize inflammation, enhance mobility, and shorten LOS following TKA, without increasing the risk of complications. An additional dose could be requisite when fibrinolysis maintains after 5-dose regimen has already been performed. LEVEL OF EVIDENCE: I.
RCT Entities:
PURPOSE: To assess the efficacy and safety of multiple-dose intravenous tranexamic acid (IV-TXA) on blood loss following total knee arthroplasty (TKA). METHODS: One hundred fifty nine patients received one bolus of IV-TXA before skin incision and two boluses three and six hours later (group A), or another bolus nine hours later (group B), or another two boluses nine and 12 hours later (group C). The primary outcomes were total blood loss (TBL), hidden blood loss (HBL), and maximum haemoglobin (Hb) drop. Other outcome measurements such as fibrinolysis parameters [fibrin(-ogen) degradation products (FDP), D-dimer], inflammatory factors [interleukin-6 (IL-6)], transfusion rate, range of motion (ROM), length of hospital stay (LOH), and complications were also recorded and compared. RESULTS: The mean TBL, HBL and maximum Hb drop in group C (p < 0.001, p < 0.001, p = 0.025) and group B (p = 0.025, p = 0.025, p = 0.044) were lower than those in group A. FDP and D-Dimer in group C was lower than in group A and B on post-operative day one. IL-6 in group A, B and C showed a downward tendency on post-operative days one and three (POD1 and POD3). Moreover, the ROM and LOH were better in group C. No episodes of transfusion or deep venous thrombosis (DVT) were detected in all groups. CONCLUSIONS: The 5-dose TXA regimen can further reduce the blood loss, diminish the maximum Hb drop, minimize inflammation, enhance mobility, and shorten LOS following TKA, without increasing the risk of complications. An additional dose could be requisite when fibrinolysis maintains after 5-dose regimen has already been performed. LEVEL OF EVIDENCE: I.
Authors: Marcin Krzysztof Wasko; Konstancja Bobecka-Wesołowska; Ryszard Tomasiuk; Jacek Kowalczewski Journal: Clin Chem Lab Med Date: 2015-10 Impact factor: 3.694
Authors: Juan J Jiménez; José L Iribarren; Maitane Brouard; Domingo Hernández; Salomé Palmero; Alejandro Jiménez; Leonardo Lorente; Patricia Machado; Juan M Borreguero; José M Raya; Beatriz Martín; Rosalía Pérez; Rafael Martínez; María L Mora Journal: J Cardiothorac Surg Date: 2011-10-14 Impact factor: 1.637