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Blood Conservation

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F Escolano – 1st expert on this subject based on the ideXlab platform

  • tranexamic acid reduces Blood transfusion in total knee arthroplasty even when a Blood Conservation program is applied
    Transfusion, 2008
    Co-Authors: J C Alvarez, Francisco X Santiveri, Isabel Ramos, Enrique Vela, Lluis Puig, F Escolano

    Abstract:

    BACKGROUND: In total knee arthroplasty surgery, a Blood Conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a Blood Conservation program is applied.

    STUDY DESIGN AND METHODS: In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established Blood Conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol.

    RESULTS: Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous Blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total Blood loss on the fourth postoperative day was [mean (±SD)] 1744 (±804) mL in controls compared with 1301 (±621) mL in the tranexamic acid group (p < 0.05). Eleven units of Blood were transfused (6 patients) in the control group versus one in the tranexamic acid group (p < 0.05). Only 2 patients (4%) in the tranexamic acid group received reinfusion of Blood recovered by drains compared with 36 (73%) in the control group (p < 0.0001). No thromboembolic complications were detected. CONCLUSION: Tranexamic acid reduces Blood losses and transfusion requirements even when a Blood Conservation program was used and it questions the usefulness of the postoperative reinfusion drains.

  • Tranexamic acid reduces Blood transfusion in total knee arthroplasty even when a Blood Conservation program is applied
    Transfusion, 2007
    Co-Authors: J C Alvarez, Francisco X Santiveri, Isabel Ramos, Enrique Vela, Lluis Puig, F Escolano

    Abstract:

    BACKGROUND: In total knee arthroplasty surgery, a Blood Conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a Blood Conservation program is applied.

    STUDY DESIGN AND METHODS: In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established Blood Conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol.

    RESULTS: Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous Blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total Blood loss on the fourth postoperative day was [mean (±SD)] 1744 (±804) mL in controls compared with 1301 (±621) mL in the tranexamic acid group (p 

J C Alvarez – 2nd expert on this subject based on the ideXlab platform

  • tranexamic acid reduces Blood transfusion in total knee arthroplasty even when a Blood Conservation program is applied
    Transfusion, 2008
    Co-Authors: J C Alvarez, Francisco X Santiveri, Isabel Ramos, Enrique Vela, Lluis Puig, F Escolano

    Abstract:

    BACKGROUND: In total knee arthroplasty surgery, a Blood Conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a Blood Conservation program is applied.

    STUDY DESIGN AND METHODS: In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established Blood Conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol.

    RESULTS: Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous Blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total Blood loss on the fourth postoperative day was [mean (±SD)] 1744 (±804) mL in controls compared with 1301 (±621) mL in the tranexamic acid group (p < 0.05). Eleven units of Blood were transfused (6 patients) in the control group versus one in the tranexamic acid group (p < 0.05). Only 2 patients (4%) in the tranexamic acid group received reinfusion of Blood recovered by drains compared with 36 (73%) in the control group (p < 0.0001). No thromboembolic complications were detected. CONCLUSION: Tranexamic acid reduces Blood losses and transfusion requirements even when a Blood Conservation program was used and it questions the usefulness of the postoperative reinfusion drains.

  • Tranexamic acid reduces Blood transfusion in total knee arthroplasty even when a Blood Conservation program is applied
    Transfusion, 2007
    Co-Authors: J C Alvarez, Francisco X Santiveri, Isabel Ramos, Enrique Vela, Lluis Puig, F Escolano

    Abstract:

    BACKGROUND: In total knee arthroplasty surgery, a Blood Conservation program is applied as a normal clinical practice to avoid allogenic transfusions. The objective of this study was to assess the effectiveness of tranexamic acid to reduce transfusions in total knee replacement even when a Blood Conservation program is applied.

    STUDY DESIGN AND METHODS: In a double-blind prospective study the patients scheduled for total knee arthroplasty were included in a well-established Blood Conservation program and then randomly assigned into two groups: In tranexamic acid group, 10 mg per kg ev bolus followed by 1 mg per kg per hour perfusion was administered, while in the control group, saline was given matching the protocol.

    RESULTS: Ninety-five patients were included (tranexamic acid group, 46; control group, 49). Thirty-three patients (34.7%) underwent preoperative procedures to reduce transfusions: presurgical autologous Blood donation (12), recombinant erythropoietin (6), and elementary iron (15); postoperative drain for reinfusion was allocated in all the cases. Total Blood loss on the fourth postoperative day was [mean (±SD)] 1744 (±804) mL in controls compared with 1301 (±621) mL in the tranexamic acid group (p 

Donald R Earles – 3rd expert on this subject based on the ideXlab platform

  • a Blood Conservation algorithm to reduce Blood transfusions after total hip and knee arthroplasty
    Journal of Bone and Joint Surgery American Volume, 2004
    Co-Authors: Jeffery L Pierson, Timothy J Hannon, Donald R Earles

    Abstract:

    Background: Donation of autologous Blood before total joint arthroplasty is inconvenient and costly, causes a phlebotomy-induced anemia, and may be wasteful and unnecessary for the nonanemic patient. We developed a BloodConservation algorithm that does not require predonation of autologous Blood, employs selective use of epoetin alfa, and uses evidence-based transfusion criteria. Our hypothesis was that use of this algorithm would reduce the rate of transfusion after unilateral total hip and knee arthroplasty as compared with the rates described in previous reports.

    Methods: We retrospectively reviewed the records of 500 consecutive patients in whom unilateral primary total hip or knee arthroplasty had been performed by a single surgeon. The same BloodConservation algorithm was recommended to all patients. Two groups of patients were identified: the first group consisted of 433 patients in whom the algorithm was followed, and the second group consisted of sixty-seven patients in whom the algorithm was not followed.

    Results: In the group in which the algorithm was followed, the rates of allogeneic transfusion after total knee and total hip arthroplasty were 1.4% (three of 220) and 2.8% (six of 213), respectively. The overall rate of transfusion in this group was only 2.1% (nine of 433). The prevalence of transfusion in the group in which the algorithm was not followed was 16.4% (eleven of sixty-seven). This difference was significant (p = 0.0001).

    Conclusions: The use of this BloodConservation algorithm resulted in a significant reduction in the need for allogeneic Blood transfusions after unilateral total hip and knee arthroplasty, and the results compare favorably with the rates of transfusion described in previous reports.

    Level of Evidence: Therapeutic study, Level III-2 (retrospective cohort study). See Instructions to Authors for a complete description of levels of evidence.