Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty Decreases the Rate of Post-operative Blood Transfusio
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ORIGINAL ARTICLE
Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty Decreases the Rate of Post-operative Blood Transfusions in People with Hemophilia: A Retrospective Case-Control Study E. Carlos Rodriguez-Merchan, MD, PhD
& Carlos
A. Encinas-Ullan, MD & Primitivo Gomez-Cardero, MD
Received: 12 April 2019/Accepted: 15 July 2019 * Hospital for Special Surgery 2019
Abstract Background: Blood transfusion rates after total knee arthroplasty (TKA) in patients without hemophilia have diminished with the use of a standardized multimodal blood loss prevention method (MBLPM) that includes intraarticular tranexamic acid (TXA) (MBLPM-TXA). However, the topic has not been addressed in people with hemophilia. Questions/Purposes: Our aim was to investigate whether the MBLPM-TXA prevents blood loss in patients with hemophilia A who undergo TKA, thereby decreasing the need for post-operative blood transfusion. Methods: This retrospective case–control comparative study involved 30 TKA patients who had a severe degree of hemophilia A without inhibitions: one group treated with the MBLPM-TXA (n = 15) and a second group treated without it (n = 15). In all cases, the pre-operative hemoglobin level was greater than 13 g/dL. Results: The MBLPM-TXA group had a transfusion rate of zero, whereas 46.6% of the patients (seven of 15) in the non–MBLPM-TXA group needed transfusion. Conclusion: This retrospective case–control study showed that the use of an MBLPM-TXA in patients with hemophilia A who underwent TKA was effective in reducing rates of transfusion. We recommend its use.
Level of Evidence: Level III, Retrospective Case–Control Study Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11420-019-09711-0) contains supplementary material, which is available to authorized users. E. C. Rodriguez-Merchan, MD, PhD (*) : C. A. Encinas-Ullan, MD : P. Gomez-Cardero, MD Department of Orthopaedic Surgery, La Paz University Hospital– IdiPaz, Paseo de la Castellana 261, 28046, Madrid, Spain e-mail: [email protected]
Keywords hemophilia . total knee arthroplasty . post-operative blood loss . blood loss prevention . tranexamic acid . multimodal blood loss prevention method
Introduction Total knee arthroplasty (TKA) has traditionally been associated with blood loss necessitating allogeneic blood transfusion, with rates ranging from 9 to 84% (mean, 44%) [13]. Allogeneic blood transfusion remains a standard treatment in cases of post-operative anemia after TKA, and at many institutions, clinicians prepare 2 units of packed red blood cells before TKA is performed. However, the risks associated with allogeneic blood transfusion are well established [7]. Many authors have reported the efficacy and safety of intravenous [4, 5, 8, 9, 14, 16, 17] and intra-articular [2, 3, 6, 10– 12, 15, 18, 19] tranexamic acid (TXA) in preventing blood loss during TKA. The use of a multimodal blood loss prevention method (MBLPM) that includes intra-articular TXA (MBLPMTXA) has been shown to diminish the t
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