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Tek seferlik yüksek doz topikal traneksamik asit uygulamasının total diz artroplastisi sonrası kanama ve komplikasyonlar üzerine etkisi: Retrospektif klinik çalışma

Year 2020, , 294 - 299, 30.09.2020
https://doi.org/10.18663/tjcl.791064

Abstract

Amaç: Literatürde ortopedik cerrahide Traneksamik asit (TA) kullanımının optimal yöntemi konusunda fikir birliği yoktur. Bu çalışmanın amacı, total diz artroplastisi (TDA) cerrahisinde tek yüksek doz (3g) topikal TA uygulamasının postoperatif kanama ve komplikasyonlar üzerine etkilerini değerlendirmektir.
Gereç ve Yöntemler: Ocak 2016 - Haziran 2018 tarihleri arasında kliniğimizde TDA uygulanan hastalar retrospektif olarak değerlendirildi. Hastalar TA uygulamasına göre iki gruba ayrıldı: Grup 1 (topikal TA, n = 105/242) ve Grup 2 (TA olmayan, n = 137/242). Demografik parametreler, komorbiditeler, yüksek risk faktörleri, preoperatif hemoglobin (Hb) düzeyi, postoperatif en düşük Hb düzeyi, Hb'deki toplam değişiklik, toplam dren çıkışı, transfüzyon varlığı veya yokluğu, transfüzyon yapılan kan miktarı, hastanede kalış süresi ve komplikasyonlar değerlendirildi.
Bulgular: Grup 1'de postoperatif birinci ve ikinci gün Hb seviyeleri grup 2'ye göre anlamlı olarak yüksekti. Grup 1'de ameliyat günü kan kaybı, ameliyat sonrası ilk gün kan kaybı ve toplam dren kan kaybı anlamlı olarak daha düşüktü. Grup 2'deki hastaların anlamlı olarak daha fazla kan transfüzyonuna ihtiyaç duydukları ve hastanede kalış sürelerinin daha uzun olduğu belirlendi. İki grup arasındaki komplikasyonlarda istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: Bu çalışmada, TA'nın yara kapatıldıktan sonra diz eklemine topikal uygulaması; primer TDA yapılan hastalarda tromboembolik riskte bir artış yaratmadan, postoperatif Hb kaybını ve kan kaybını önemli ölçüde azaltmıştır. Bu durum hastanede kalış süresini de azaltmaktadır.

References

  • 1. Cannada L. Orthopaedic knowledge update 11. Rosemont: American Academy of Orthopaedic Surgeons. 2014.
  • 2. 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: 1442-8.
  • 3. Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013; 20: 300-9.
  • 4. Dai WL, Zhou AG, Zhang H, Zhang J. Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Knee Surg 2018; 31: 654-63.
  • 5. Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. Orthopedics 2016; 39: 119-30.
  • 6. Spanyer J, Patel J, Emberton E, Smith LS, Malkani AL. Topical Tranexamic Acid in Total Knee Arthroplasty Patients with Increased Thromboembolic Risk. J Knee Surg 2017; 30: 474-8.
  • 7. Wang S, Gao X, An Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Int Orthop 2017; 41: 739-48.
  • 8. Sa-Ngasoongsong P, Wongsak S, Chanplakorn P, Woratanarat P, Wechmongkolgorn S, Wibulpolprasert B, Mulpruek P, Kawinwonggowit V. Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC musculoskeletal disorders 2013; 14: 340.
  • 9. Wong J, Abrishami A, El Beheiry H et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. JBJS 2010; 92: 2503-13.
  • 10. Tammachote N, Raphiphan R, Kanitnate S. High-dose (3 g) topical tranexamic acid has higher potency in reducing blood loss after total knee arthroplasty compared with low dose (500 mg): a double blind randomized controlled trial. European Journal of Orthopaedic Surgery & Traumatology 2019; 1-7.
  • 11. Moskal JT, Capps SG. Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis. J Knee Surg 2018; 31: 56-67.
  • 12. Yuan X, Li B, Wang Q, Zhang X. Comparison of 3 Routes of Administration of Tranexamic Acid on Primary Unilateral Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty 2017; 32: 2738-43.
  • 13. Abdel MP, Chalmers BP, Taunton MJ et al. Intravenous Versus Topical Tranexamic Acid in Total Knee Arthroplasty: Both Effective in a Randomized Clinical Trial of 640 Patients. J Bone Joint Surg Am 2018; 100: 1023-9.
  • 14. Akgul T, Buget M, Salduz A, Edipoglu IS, Ekinci M, Kucukay S, Sen C. Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study. Acta Orthop Traumatol Turc. 2016; 50: 429-31.
  • 15. Aytuluk HG, Yaka HO. Tranexamic acid is effective in lower doses with infusion in total knee arthroplasty. Acta Orthop Traumatol Turc 2019; 53: 81-5.
  • 16. Pinsornsak P, Rojanavijitkul S, Chumchuen S. Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord 2016; 17: 313

Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study

Year 2020, , 294 - 299, 30.09.2020
https://doi.org/10.18663/tjcl.791064

Abstract

Aim: There is no consensus on the optimal method of Tranexamic acid (TA) usage in orthopaedic surgery in the literature. The aim of this study is to evaluate the effects of single high dose (3g) topical TA application on postoperative bleeding and complications in total knee arthroplasty (TKA) surgery.
Material and Methods: We retrospectively evaluated patients who underwent TKA in our clinic between January 2016 and June 2018. The patients were divided into two groups according to TA administration: Group 1 (topical TA, n=105/242) and Group 2 (non-TA, n=137/242). Demographic parameters, comorbidities, high-risk factors, preoperative hemoglobin (Hb) level, lowest postoperative Hb level, change in Hb, total drainage output, presence or absence of a transfusion, amount of blood transfused, length of stay, and complications were evaluated.

Results:In group 1, postoperative first- and second-day Hb levels were significantly higher than those in group 2. The blood loss on the day of surgery, the blood loss on the first postoperative day and total drain blood loss were significantly lower in group 1. It was determined that the patients in group 2 needed significantly more blood transfusions and had more length of hospital stay. There was no statistical difference in complications between the two groups.
Conclusion:Topical TA application effectively and significantly reduces blood loss and transfusion rates after surgery, without serious side effects, in patients undergoing primary TKA. This also reduces the length of the hospital stay.

References

  • 1. Cannada L. Orthopaedic knowledge update 11. Rosemont: American Academy of Orthopaedic Surgeons. 2014.
  • 2. 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: 1442-8.
  • 3. Panteli M, Papakostidis C, Dahabreh Z, Giannoudis PV. Topical tranexamic acid in total knee replacement: a systematic review and meta-analysis. Knee 2013; 20: 300-9.
  • 4. Dai WL, Zhou AG, Zhang H, Zhang J. Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials. J Knee Surg 2018; 31: 654-63.
  • 5. Lin ZX, Woolf SK. Safety, Efficacy, and Cost-effectiveness of Tranexamic Acid in Orthopedic Surgery. Orthopedics 2016; 39: 119-30.
  • 6. Spanyer J, Patel J, Emberton E, Smith LS, Malkani AL. Topical Tranexamic Acid in Total Knee Arthroplasty Patients with Increased Thromboembolic Risk. J Knee Surg 2017; 30: 474-8.
  • 7. Wang S, Gao X, An Y. Topical versus intravenous tranexamic acid in total knee arthroplasty: a meta-analysis of randomized controlled trials. Int Orthop 2017; 41: 739-48.
  • 8. Sa-Ngasoongsong P, Wongsak S, Chanplakorn P, Woratanarat P, Wechmongkolgorn S, Wibulpolprasert B, Mulpruek P, Kawinwonggowit V. Efficacy of low-dose intra-articular tranexamic acid in total knee replacement; a prospective triple-blinded randomized controlled trial. BMC musculoskeletal disorders 2013; 14: 340.
  • 9. Wong J, Abrishami A, El Beheiry H et al. Topical application of tranexamic acid reduces postoperative blood loss in total knee arthroplasty: a randomized, controlled trial. JBJS 2010; 92: 2503-13.
  • 10. Tammachote N, Raphiphan R, Kanitnate S. High-dose (3 g) topical tranexamic acid has higher potency in reducing blood loss after total knee arthroplasty compared with low dose (500 mg): a double blind randomized controlled trial. European Journal of Orthopaedic Surgery & Traumatology 2019; 1-7.
  • 11. Moskal JT, Capps SG. Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis. J Knee Surg 2018; 31: 56-67.
  • 12. Yuan X, Li B, Wang Q, Zhang X. Comparison of 3 Routes of Administration of Tranexamic Acid on Primary Unilateral Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. J Arthroplasty 2017; 32: 2738-43.
  • 13. Abdel MP, Chalmers BP, Taunton MJ et al. Intravenous Versus Topical Tranexamic Acid in Total Knee Arthroplasty: Both Effective in a Randomized Clinical Trial of 640 Patients. J Bone Joint Surg Am 2018; 100: 1023-9.
  • 14. Akgul T, Buget M, Salduz A, Edipoglu IS, Ekinci M, Kucukay S, Sen C. Efficacy of preoperative administration of single high dose intravenous tranexamic acid in reducing blood loss in total knee arthroplasty: A prospective clinical study. Acta Orthop Traumatol Turc. 2016; 50: 429-31.
  • 15. Aytuluk HG, Yaka HO. Tranexamic acid is effective in lower doses with infusion in total knee arthroplasty. Acta Orthop Traumatol Turc 2019; 53: 81-5.
  • 16. Pinsornsak P, Rojanavijitkul S, Chumchuen S. Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial. BMC Musculoskelet Disord 2016; 17: 313
There are 16 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Ekin Kaya Şimsek This is me

Bahtiyar Haberal This is me

Publication Date September 30, 2020
Published in Issue Year 2020

Cite

APA Şimsek, E. K., & Haberal, B. (2020). Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study. Turkish Journal of Clinics and Laboratory, 11(4), 294-299. https://doi.org/10.18663/tjcl.791064
AMA Şimsek EK, Haberal B. Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study. TJCL. September 2020;11(4):294-299. doi:10.18663/tjcl.791064
Chicago Şimsek, Ekin Kaya, and Bahtiyar Haberal. “Effects of Single High Dose Topical Tranexamic Acid Administration on Bleeding and complicatıons After Total Knee Arthroplasty surgery:A Retrospective Clinical Study”. Turkish Journal of Clinics and Laboratory 11, no. 4 (September 2020): 294-99. https://doi.org/10.18663/tjcl.791064.
EndNote Şimsek EK, Haberal B (September 1, 2020) Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study. Turkish Journal of Clinics and Laboratory 11 4 294–299.
IEEE E. K. Şimsek and B. Haberal, “Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study”, TJCL, vol. 11, no. 4, pp. 294–299, 2020, doi: 10.18663/tjcl.791064.
ISNAD Şimsek, Ekin Kaya - Haberal, Bahtiyar. “Effects of Single High Dose Topical Tranexamic Acid Administration on Bleeding and complicatıons After Total Knee Arthroplasty surgery:A Retrospective Clinical Study”. Turkish Journal of Clinics and Laboratory 11/4 (September 2020), 294-299. https://doi.org/10.18663/tjcl.791064.
JAMA Şimsek EK, Haberal B. Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study. TJCL. 2020;11:294–299.
MLA Şimsek, Ekin Kaya and Bahtiyar Haberal. “Effects of Single High Dose Topical Tranexamic Acid Administration on Bleeding and complicatıons After Total Knee Arthroplasty surgery:A Retrospective Clinical Study”. Turkish Journal of Clinics and Laboratory, vol. 11, no. 4, 2020, pp. 294-9, doi:10.18663/tjcl.791064.
Vancouver Şimsek EK, Haberal B. Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study. TJCL. 2020;11(4):294-9.


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