Volume Of Postoperative Blood Loss Research Articles

Tranexamic Acid Reduces Postoperative Blood Loss in Cementless Total Hip Arthroplasty

Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin, has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip arthroplasty with cement. However, there have been few reports describing the effects of tranexamic acid on blood loss during and following total hip arthroplasty without cement. We investigated the effects of tranexamic acid in twenty-one patients who underwent staged bilateral total hip arthroplasty without cement for the treatment of osteoarthritis of the hip. The average interval between the two procedures was 16 +/- 16 months. On one side, 1000 mg of tranexamic acid was administered intravenously five minutes before the skin incision. On the other side, tranexamic acid was not administered. Baseline hemoglobin and hematocrit values were obtained three weeks before each arthroplasty. The volume of postoperative blood loss was recorded at two-hour intervals for the first twelve hours and then again at twenty-four hours, and the values were compared between the two groups. The total intraoperative blood loss in the tranexamic acid group (607 +/- 298 mL) was similar to that in the control group (633 +/- 220 mL). The postoperative blood loss in the tranexamic acid group was significantly lower than that in the control group at all time-points during the first twenty-four hours (p < 0.001 for all comparisons). The greatest reduction in blood loss was observed during the first four hours after surgery in the tranexamic acid group (p < 0.01). In patients undergoing total hip arthroplasty without cement, preoperative administration of tranexamic acid is associated with decreased postoperative blood loss during the first twenty-four hours, especially during the first four hours after surgery.

Comprehensive Multimodality Blood Conservation: 100 Consecutive CABG Operations Without Transfusion

Background. Despite the recent introduction of a number of technical and pharmacologic blood conservation measures, bleeding and allogeneic transfusion remain persistent problems in open heart surgical procedures. We hypothesized that a comprehensive multimodality blood conservation program applied algorithmically on the basis of bleeding and transfusion risk would provide a maximum, cost-effective, and safe reduction in postoperative bleeding and allogeneic blood transfusion. Methods. One hundred consecutive patients undergoing coronary artery bypass grafting were prospectively enrolled in a risk factor–based multimodality blood conservation program (MMD group). To evaluate the relative efficacy and safety of this comprehensive approach, comparison was made with a similar group of 90 patients undergoing coronary artery bypass grafting to whom the multimodality blood conservation program was not applied but in whom an identical set of transfusion guidelines was enforced (control group). To evaluate the cost effectiveness of the multimodality program, comparison was also made between patients in the MMD group and a consecutive series of contemporaneous, diagnostic-related group–matched patients. Results. One hundred consecutive patients in the MMD group underwent coronary artery bypass grafting without allogeneic transfusion. This compared favorably with the control population in whom a mean of 2.2 ± 6.7 units of allogeneic blood was transfused per patient (34 patients [38%] received transfusion). In addition, the volume of postoperative blood loss at 12 hours in the control group was almost double that of the MMD group (660 ± 270 mL versus 370 ± 180 mL [ p < 0.001]). Total costs for the MMD group in each of the three major diagnostic-related groups were equivalent to or significantly less than those in the consecutive series of diagnostic-related group–matched patients. Conclusions. Comprehensive risk factor–based application of multiple blood conservation measures in an optimized, integrated, and algorithmic manner can significantly decrease bleeding and need of allogeneic transfusion in coronary artery bypass grafting in a safe and cost-effective manner.