Blood Loss In Hip Arthroplasty Research Articles

Role of tranexamic acid (TXA) administered locally into the surgical site intraoperatively in reducing the post-operative blood loss in hip Arthroplasty

Total hip arthroplasty (THA) has revolutionized the quality of life of men and women of all ages since the 1960s, earning the title of “the operation of the century. Being a measure surgery there is considerable loss of blood in intra and post operative period along with drop in the level of hemoglobin. Average blood loss is around 1000ml (450 to 1900ml) and the mean hemoglobin fall is 2.1 ± 1.1 g/dl. There are various methods available to control and decrease the blood loss intra and post operatively. Systemic administration of tranexamic acid has been studied and its effectiveness being proved in literature and commonly being used in orthopedics, gynecology and neuro surgery. But, Administration and the effects of tranexamic acid into the operative site haven’t been published in literature, to the best of our knowledge. Present study is based on the estimation of effectiveness of TXA at the surgical site after wound closure.

Tranexamic acid reduces blood loss in hip arthroplasty for senile femoral neck fracture

Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid (TXA) on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture. Methods From January 2016 to August 2017, 118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics, China-Japan Friendship Hospital. They were 45 males and 73 females, with an average age of 77.1 years. Of them, 60 (TXA group) were subjected to intravenous TXA dripping over 10 minutes by 2 doses (15 mg/kg TXA dissolved in 100 mL of saline) with the first dose before incision and the second one at wound closure; 58 (control group) were subjected to intravenous administration of 100 mL of saline solution in a similar fashion. Blood routine tests were carried out one day before operation, and the first and third days after operation. The transfusion rate and volume, and surgical blood loss were recorded. The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method. The 2 groups were compared in terms of blood loss and complications. Results The blood transfusion rate (21.7%), blood transfusion volume (310.8±85.7 mL), surgical blood loss (424.3±87.6 mL), total blood loss on postoperative 1-day (1,284.6±288.7 mL) and total blood loss on postoperative 3-day (1,501.2±337.1 mL) in the TXA group were all significantly lower than those in the control group (41.4%, 379.8±110.2 mL, 526.7±113.8 mL, 1,534.8±279.2 mL and 1,887.4±431.8 mL, respectively) (P 0.05). Conclusion In elderly patients undergoing hip arthroplasty for femoral neck fracture, intravenous TXA administration may lower transfusion rate, reduce transfusion volume, and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis. Key words: Tranexamic acid; Femoral neck fractures; Arthroplasty, replacement, hip; Postoperative hemorrhage

Is tranexamic acid exposure related to blood loss in hip arthroplasty? A pharmacokinetic-pharmacodynamic study.

Tranexamic acid (TXA) is an antifibrinolytic agent, decreasing blood loss in hip arthroplasty. The present study investigated the relationship between TXA exposure markers, including the time above the in vitro threshold reported for inhibition of fibrinolysis (10mg l-1 ), and perioperative blood loss. Data were obtained from a prospective, double-blind, parallel-arm, randomized superiority study in hip arthroplasty. Patients received a preoperative intravenous bolus of TXA 1g followed by a continuous infusion of either TXA 1g or placebo over 8h. A population pharmacokinetic study was conducted to quantify TXA exposure. In total, 827 TXA plasma concentrations were measured in 166 patients. A two-compartment model fitted the data best, total body weight determining interpatient variability in the central volume of distribution. Creatinine clearance accounted for interpatient variability in clearance. At the end of surgery, all patients had TXA concentrations above the therapeutic target of 10mg l-1 . The model-estimated time during which the TXA concentration was above 10mg l-1 ranged from 3.3h to 16.3h. No relationship was found between blood loss and either the time during which the TXA concentration exceeded 10mg l-1 or the other exposure markers tested (maximum plasma concentration, area under the concentration-time curve). In hip arthroplasty, TXA plasma concentrations were maintained above 10mg l-1 during surgery and for a minimum of 3h with a preoperative TXA dose of 1g. Keeping TXA concentrations above this threshold up to 16h conferred no advantage with regard to blood loss.

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus.

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

Efficiency of tranexamic acid in perioperative blood loss in hip arthroplasty: A systematic literature review and meta-analysis

Introduction and objectiveTranexamic acid (TXA) is an antifibrinolytic drug used to reduce bleeding in mortality risk situations such as trauma. Our objective was to conduct a systematic literature review to evaluate the effectiveness and safety of TXA in reducing bleeding in hip arthroplasty. Materials and methodsA systematic literature review and meta-analysis of primary studies similar to controlled trials was performed. Literature was searched in MEDLINE, Embase, Cochrane, LILACS, SciELO and Google Scholar. The review was proposed and undertaken by two reviewers and the inclusion criteria were: (a) patients undergoing arthroplasty for primary unilateral hip replacement; (b) comparison of a treatment group with TXA to a control group that received a placebo or no treatment at all, and (c) outcome measures, total blood loss, number of patients receiving allogeneic transfusion and/or incidence of thromboembolic complications. The search was restricted to studies published from 1966 to June 2013. ResultsA total of 16 studies with 246 patients were retrieved for this review. The total blood loss outcome evidenced a weighted mean difference in favor of TXA vs. controls undergoing hip arthroplasty (−0.45 [P<0.001, 95% CI −0.65 to −0.24]). Weighted relative risk was estimated for the allogeneic transfusion requirement outcome, showing a trend in favor the TXA arm, with fewer patients requiring allogeneic transfusion in hip surgery (0.8 [P<0.02, 95% CI 0.57–1.11]); however, this trend was not statistically significant. LimitationsThere is a noticeable difference in methods for quantifying total blood loss across the studies reviewed. The need for transfusion outcomes is probably not significant taking into account the number of events in the TXA group. ConclusionsTXA can be routinely used to reduce intra- and post-operative blood loss in primary hip arthroplasty.

Angiotensin-converting enzyme gene polymorphism may influence blood loss in a geriatric population undergoing total hip arthroplasty.

To evaluate how angiotensin-converting enzyme (ACE) gene polymorphism is associated with perioperative blood loss in hip arthroplasty in a geriatric population. A case-control study of subjects consecutively undergoing total hip arthroplasty. A department of orthopedic surgery in Italy. One hundred five patients, mean age +/- standard deviation 68.6 +/- 10.4, undergoing total hip arthroplasty. ACE gene polymorphism was analyzed using polymerase chain reaction. Decrement of hemoglobin (Hb) and hematocrit (Ht) was calculated as the difference between the preoperative and the lowest postoperative value, measured 1, 2, and 3 days after surgery. Total blood loss was calculated as the sum of intra- and postoperative blood loss. Patients carrying the deletion homozygous and insertion/deletion heterozygous genotypes of the ACE gene show a higher decrement of Hb (P <.01) and Ht (P <.01) and higher total blood loss (P <.007) after hip surgery than subjects carrying the insertion (II) homozygous. The role of ACE gene polymorphism seems hypertension independent. Logistic regression analysis showed that II genotype reduces total blood loss. This is the largest study evaluating the distribution of ACE gene genotypes in patients undergoing hip arthroplasty and the first investigating the association between bleeding and ACE gene polymorphism. Our data suggest that II genotype is associated with lower total blood loss.