Predicting Need for Allogeneic Transfusion After Total Knee Arthroplasty

Noticewala, Manish S.; Nyce, Jonathan D.; Wang, Wenbao; Geller, Jeffrey A.; Macaulay, William

doi:10.1016/j.arth.2011.10.008

Cited by 98 publications

(75 citation statements)

References 25 publications

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“…We also confirmed that gender and age were not major determinants of transfusion, in coincidence with other authors [14,15] but in disagreement with authors who considered age [21]. The difference inf our study may be patient age-mostly between 70 and 80 years in our series-which could make our series less sensitive when studying the age influence.…”

Section: Transfusion (Group 2)supporting

confidence: 34%

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Moráis

Ortega-Andreu

Rodríguez-Merchán

et al. 2013

International Orthopaedics (SICOT)

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Purpose Our aim was to clarify the effective decrease in blood transfusion after primary total knee arthroplasty (TKA) from a multimodal blood-loss prevention approach (MBLPA) and the related risk factors of blood transfusion. Methods We retrospectively compared the rate of postoperative blood transfusion in 418 cases of primary TKA during 2010 from a single institution with two different groups of patients, allocating cases to the group with MBLPA (group 1, study group, N =71) and controls to the group without MBLPA (group 2, standard group, N =347). MBLPA procedure included pre-operative haemoglobin (Hb) optimisation; femoral canal obturation; limited incision and release; periand intra-articular use of saline with adrenalin, morpheic chloride, tobramycin, betamethasone and ropivacaine; tourniquet release after skin closure; 24 hour drain under atmospheric pressure; and two doses of tranexamic acid (TXA) IV. In the control group, surgeons followed the standard procedure without blood-saving techniques. Case-control comparison and blood transfusion risk factors were analysed. Results Group 1 had a zero transfusion rate (0/71), whereas 27.4 % of patients (95/347) in group 2 received allogenic blood transfusion. Significant transfusion risk factors were pre-operative Hb <12 g/dl), American Society of Anesthesiologists (ASA) status III and nonobese body mass index (BMI); Age and gender were not significant risk factors. Conclusions MBLPA in primary TKA was highly effective, with a zero transfusion rate. Risk factors for transfusion were determined, and eliminating them contributed to the avoidance of allogeneic blood transfusion in our study series.

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Section: Transfusion (Group 2)supporting

confidence: 34%

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Moráis

Ortega-Andreu

Rodríguez-Merchán

et al. 2013

International Orthopaedics (SICOT)

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“…Many of these investigations demonstrated preoperative Hgb value to be a significant predictor of postoperative transfusion [23][24][25][26]. As such, there are certain preoperative Hgb levels where postoperative transfusion is less likely and the utility of TXA is unknown.…”

mentioning

confidence: 99%

Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

Whiting

Duncan

Sierra

et al. 2015

The Journal of Arthroplasty

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While tranexamic acid (TXA) reduces transfusion in total joint arthroplasty (TJA), it remains unclear whether there is a preoperative hemoglobin (Hgb) threshold above which it is no longer beneficial. 2100 primary TJA patients were retrospectively categorized by preoperative Hgb; 1161 (55%) received TXA. Transfusion rates decreased with TXA in all groups; with Hgb>15 the transfusion rate was 0.5% with TXA and 4.5% without (P=0.0086); with Hgb>11 the transfusion rate was 4.7% with TXA and 18.7% without (P<0.0001). Patients receiving TXA had a shorter LOS by 0.51 days (P<0.0001). Patients receiving a postoperative transfusion had a longer LOS by 0.69 days (P<0.0001). TXA should be considered in all TJA patients independent of preoperative Hgb level.

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“…However, one of the most important postoperative complications is excessive blood loss, which cannot be completely avoided. 1,2 Significant blood loss requires further allogenous blood transfusion, which may lead to catastrophic risks such as infection, immunological reaction, and even mortality. 3,4 Tranexamic acid (TEA), a synthetic lysine derivative, can inhibit fibrinolysis by reversibly blocking the lysine binding site of plasminogen to plasmin.…”

Section: Introductionmentioning

confidence: 99%

Comparison of clinical results for patients undergoing unilateral total knee replacement with or without tranexamic acid

2017

JCGG

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Predicting Need for Allogeneic Transfusion After Total Knee Arthroplasty

Cited by 98 publications

References 25 publications

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Blood transfusion after primary total knee arthroplasty can be significantly minimised through a multimodal blood-loss prevention approach

Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

Comparison of clinical results for patients undergoing unilateral total knee replacement with or without tranexamic acid

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