Defining the most effective patient blood management combined with tranexamic acid regime in primary uncemented total hip replacement surgery
Entidad
UAM. Departamento de Cirugía; Instituto de Investigación Sanitaria Hospital Universitario de La Paz (IdiPAZ)Editor
MDPI, Basel, SwitzerlandFecha de edición
2020-06-22Cita
10.3390/jcm9061952
Journal of Clinical Medicine 9.6 (2020): 1952
ISSN
077-0383DOI
10.3390/jcm9061952Versión del editor
https://doi.org/10.3390/jcm9061952Materias
uncemented total hip replacement; patient blood management; tranexamic acid; optimal protocol; bloodless medicine; MedicinaDerechos
© 2020 The authorsResumen
The application of patient blood management (PBM) combined with tranexamic acid
administration (TXA) results in decreased total blood loss volume (TVB) and transfusions in total hip
replacements (THRs). Dosages, timing, and routes of administration of TXA are still under debate as
all these aspects, as well as interpatient variations, may a ect the e cacy of the protocol. This study
aims to examine the e ectiveness of timing and route of administration of TXA in combination with
PBM by reducing the TBV following THR surgery. Consecutive primary uncemented THRs operated
by a single surgical and anaesthetic team had the data prospectively collected and then retrospectively
studied. Five treatment groups were formed, reflecting the progressive evolution of our protocol.
Group 1 included patients managed with PBM alone (preoperative erythrocyte mass optimisation
to at least 14 g/dL haemoglobin (Hb), hypotensive spinal anaesthesia and restrictive red blood cell
transfusion criteria). Group 2 included patients with PBM and topical 3 g TXA diluted in normal
saline to a total volume of 50 mL. Group 3 were patients with PBM and an IV dose of 20 mg/kg TXA
at induction, followed by 20 mg/kg TXA as a continuous infusion for the duration of the operation.
Group 4 consisted of patients managed as per Group 3 plus another 20 mg/kg TXA at three-hour
post-procedure. Group 5 (combined): PBM and IV TXA as per Group 4 and topical TXA as per Group
2. A generalised linear model with the treatment group as an independent variable was modelled,
using TBV as the dependent variable. The transfusion rate for all groups was 0%. TBV at 24 h,
oscillated from 613.5 337.63 mL in Group 1 to 376.29 135.0 mL in Group 5. TBV at 48 h oscillated
from 738.3 367.3 mL (PBM group) to 434 155.2 mL (PBM + combined group). The multivariate
regression model confirmed a significant decrease of TBV in all groups with TXA compared with
the PBM-only group. Overweight and preoperative Hb were confirmed to significantly influence
TBV. The optimal regime to achieve the least TBV and a transfusion rate of 0% requires PBM and one
loading 20 mg/kg dose of TXA, followed by continuous infusion of 20 mg/kg for the duration of the
operation in uncemented THRs. Additional doses of TXA did not add a clear benefit
Lista de ficheros
Google Scholar:Pérez-Chrzanowska, Hanna
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Padilla-Eguiluz, Norma G.
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Gómez-Barrena, Enrique
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