RESEARCH ARTICLE


Tranexamic Acid in a Multimodal Blood Loss Prevention Protocol to Decrease Blood Loss in Revision Total Knee Arthroplasty: A Cohort Study#



Miguel Ortega-Andreu1, Gloria Talavera1, Norma G. Padilla-Eguiluz2, Hanna Perez-Chrzanowska3, Reyes Figueredo-Galve3, Carlos E. Rodriguez-Merchán2, Enrique Gómez-Barrena2, *
1 Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-Cantoblanco, Madrid, Spain
2 Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ-UAM, Madrid, Spain
3 Department of Orthopaedic Anaesthesiology, Hospital La Paz-Cantoblanco, Madrid, Spain


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© Ortega-Andreu et al.; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Hospital de Traumatología 1ª planta, Hospital Universitario “La Paz”, Pº Castellana 261, 28046 Madrid, Spain; Tel: +34.917277085; Fax: +34.917277085; E-mail: egomezbarrena@gmail.com


Abstract

Purpose:

To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA)

Patients and Methods:

A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol. No differences in the complexity of surgeries or case severity were detected.

Results:

A significant decrease was observed from 58% transfusion rate in the control group to 5% in the treated group. The postoperative haemoglobin drop was also significantly different. Although the use of a blood loss prevention approach including TXA was the most relevant factor in the transfusion risk (OR=15), longer surgical time also associated an increased risk of transfusion (OR=1.15).

Conclusion:

This study supports the use of a two-dose intravenous TXA under a multimodal blood loss prevention approach in revision knee replacement with significant reduction in the transfusion rate, postoperative blood loss and haemoglobin drop.

Keywords: Blood loss, Blood saving protocol, Haemoglobin drop, Multimodal protocol, Revision knee replacement, Revision total knee replacement, Tranexamic acid, Transfusion rate.