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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2012 December;63(6):465-9
Validity of tranexamic acid (TA) in reducing the risk of transfusion in the first prosthetic knee implant: prospective comparative study of 30 patients
Ranaldo D. 1, Castelli C. C. 1, Gotti V. 1, Cella E. 2
1 Unit of Orthopedics and Traumatology, Ospedali Riuniti di Bergamo, Bergamo, Italy;
2 Department of Pharmaceutics, University of Padua, Padua, Italy
AIM: The blood loss and the use of blood products for transfusion in prosthetic knee surgery is a fairly usual practice. The combined use of the surgical gesture and tourniquet leads to an increase in the fibrinolytic system and thus triggers the loss of blood. The tranexamic acid (TA) binds to an enzyme of the coagulation cascade and inhibits fibrinolysis. The aim of our study was to evaluate the effect of TA (Tranexamic Acid) in 30 patients subject to total knee arthroplasty (TKA) to reduce unilateral intra- and postoperative blood loss and to draw an optimal protocol.
METHODS: According to our protocol two doses of TA are administered, one 10 minutes prior to the activation of the tourniquet and another 10 minutes before deactivating it (time identified with the completion of the prosthetic cementation) should be administered. A dose consists of 10 mg/kg diluted in 100 mg of saline 0.9%; slow infusion for about 10 minutes.
RESULS:Postoperative losses were then assessed, as well as the use of any blood transplant. It is relevant the average value of Hb and Hct: at discharge, which on average occurred after seven days, the patients was addressed to postoperative rehabilitative institutions (range 6-9 days). The patients in the TA group were discharged with a Hb value >10.9 g/dL and Hct 38%, while those in the non-TA group at the day of discharge had an average Hb of 10.1 and Hct 34.6% (P=0.044). The values of peripheral blood counts were monitored and screened for deep vein thrombosis prophylaxis.
CONCLUSION:The absence of complications and the significant and promising results in reducing the blood loss reduced the relative number of transfusions, therefore encouraging us to continue on this path to achieve lower costs and to improve patient satisfaction.