Topical and intravenous tranexamic acid reduce blood loss compared to routine hemostasis in total knee arthroplasty: a multicenter, randomized, controlled trial
Por:
Aguilera, X, Martinez-Zapata, M, Hinarejos, P, Jordan, M, Leal, J, Gonzalez, J, Monllau, J, Celaya, F, Rodriguez-Arias, A, Fernandez, J, Pelfort, X, Puig-Verdie, LI
Publicada:
1 jul 2015
Resumen:
Tranexamic acid (TXA) is becoming widely used in orthopedic surgery to reduce blood loss and transfusion requirements, but consensus is lacking regarding the optimal route and dose of administration. The aim of this study was to compare the efficacy and safety of topical and intravenous routes of TXA with routine hemostasis in patients undergoing primary total knee arthroplasty (TKA).
We performed a randomized, multicenter, parallel, open-label clinical trial in adult patients undergoing primary TKA. Patients were divided into three groups of 50 patients each: Group 1 received 1 g topical TXA, Group 2 received 2 g intravenous TXA, and Group 3 (control group) had routine hemostasis. The primary outcome was total blood loss. Secondary outcomes were hidden blood loss, blood collected in drains, transfusion rate, number of blood units transfused, adverse events, and mortality.
One hundred and fifty patients were included. Total blood loss was 1021.57 (481.09) mL in Group 1, 817.54 (324.82) mL in Group 2 and 1415.72 (595.11) mL in Group 3 (control group). Differences in total blood loss between the TXA groups and the control group were clinically and statistically significant (p < 0.001). In an exploratory analysis differences between the two TXA groups were not statistically significant (p = 0.073) Seventeen patients were transfused. Transfusion requirements were significantly higher in Group 3 (p = 0.005). No significant differences were found between groups regarding adverse events.
We found that 1 g of topical TXA and 2 g of intravenous TXA were both safe strategies and more effective than routine hemostasis to reduce blood loss and transfusion requirements after primary TKA.
I.
Filiaciones:
Aguilera, X:
Hosp Santa Creu & Sant Pau, Orthoped Surg & Traumatol Dept, Barcelona 08025, Spain
Martinez-Zapata, M:
IIB St Pau, Iberoamer Cochrane Ctr, CIBER Epidemiol & Salud Publ CIBERESP, Barcelona 08041, Spain
Hinarejos, P:
Orthoped Surg & Traumatol Dept, Barcelona 08024, Spain
Jordan, M:
Hosp Santa Creu & Sant Pau, Orthoped Surg & Traumatol Dept, Barcelona 08025, Spain
Leal, J:
Orthoped Surg & Traumatol Dept, Barcelona 08024, Spain
Gonzalez, J:
Hosp Santa Creu & Sant Pau, Orthoped Surg & Traumatol Dept, Barcelona 08025, Spain
Monllau, J:
Orthoped Surg & Traumatol Dept, Barcelona 08024, Spain
Celaya, F:
Hosp Santa Creu & Sant Pau, Orthoped Surg & Traumatol Dept, Barcelona 08025, Spain
Rodriguez-Arias, A:
Hosp Santa Creu & Sant Pau, Dept Pharm, Barcelona 08025, Spain
Fernandez, J:
Hosp Santa Creu & Sant Pau, Dept Anesthesiol, Barcelona 08025, Spain
Pelfort, X:
Orthoped Surg & Traumatol Dept, Barcelona 08024, Spain
Puig-Verdie, LI:
Orthoped Surg & Traumatol Dept, Barcelona 08024, Spain
Green Accepted
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