The efficacy and safety of anti-fibrinolytic agents in blood management following peri-acetabular osteotomy

Abstract

Background:Blood management after peri-acetabular osteotomy (PAO) has become a serious problem. We performed a meta-analysis to evaluate the efficacy and safety of antifibrinolytics for blood management after PAO.Methods:PubMed, OVID, Embase, ScienceDirect, and Web of Science were searched up to January, 2018 without restrictions on publication date and language. We also searched the relevant publication sources. The research was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Randomized controlled trials (RCTs) and non-RCTs were included in our study. Weighted mean differences, risk difference, and 95% confidence intervals were calculated. We assessed statistical heterogeneity for each outcome with the use of a standard chi-square test and I2 statistic. The data were extracted by 2 of the co-authors independently and were analyzed by RevMan5.3. Primary outcomes were total blood loss, postoperative hemoglobin decline, and transfusion rates. Secondary outcomes were length of a hospital stay and postoperative complications.Results:Four studies including 1 RCT and 3 non-RCTs were included in our study. The present meta-analysis indicated that antifibrinolytics was associated with a significant reduction of the total blood loss, postoperative hemoglobin decline, transfusion rates, and length of a hospital stay compared with control groups. No significant differences were identified in terms of the incidence of postoperative complications.Conclusion:Intravenous antifibrinolytics was efficacious in reduction of total blood loss, postoperative hemoglobin decline, and length of a hospital stay after PAO without increasing the risk of thromboembolic complications. More high-quality RCTs with long follow-up period were necessary for proper comparisons of the efficacy and safety of antifibrinolytics with placebo.

Effectiveness of Multi‐Modal Blood Management in Bernese Periacetabular Osteotomy and Periacetabular Osteotomy with Proximal Femoral Osteotomy

“…showed a significant reduction in blood loss and transfusion rate in patients with tranexamic acid (10 mg/kg/h). A recent meta‐analysis also verified the efficacy of intravenous anti‐fibrinolytic agents in reducing blood loss during PAO 19 . However, the patients' blood loss was still tremendous even though they received tranexamic acid.…”

“…However, compared with arthroplasty, the blood loss of PAO was higher and the blood management was more challenging. There is still no certain guideline on blood management of PAO, as limited studies have analyzed all useful strategies with small sample size 4,11,19,20,24 . The The values are given as the mean and standard deviation.…”

“…The iron sucrose (200 mg, IV) or erythropoietin (PRN) was routinely used after blood donation. Tranexamic acid was used by combining intravenous (20 mg/kg) and local (0.5 g, just before incision closure) methods 19,20 . As for the surgical techniques, we emphasized the importance of personalized surgical plan, complete hemostasis, accurate and fast osteotomy, and acetabular rotation 21 .…”

Intervenções fundamentais em cirurgia: diérese, hemostasia e síntese

“…A incisão deve ter tamanho adequado de modo que permita acesso fácil aos órgãos a serem abordados e boa visibilidade do campo operatório. Intervenções fundamentais em cirurgia: diérese, hemostasia e síntese Medeiros AC, Dantas-Filho AM cirúrgicas como pinçamento e ligadura, diatermia, uso de laser e bisturi harmônico, a hemostasia pode ser realizada com agentes antifibrinolíticos, adesivos de fibrina e outros 11,12 .…”

“…(Figura 3).Intervenções fundamentais em cirurgia: diérese, hemostasia e síntese Medeiros AC, Dantas-Filho AM Bisturi harmônico22 Quanto ao bisturi frio, existem vários tamanhos e formas de lâminas de bisturi, todas descartáveis. As lâminas para bisturi podem ser classificadas quanto ao seu formato e aplicabilidade.Os cabos mais utilizados são: (figura 4)Cabo nº 3 -Permite o encaixe de lâminas pequenas, que possibilitam incisões mais críticas, delicadas (lâminas nº10,11,12,15).Cabo nº 4 -Utiliza lâminas maiores, são mais usados em procedimentos com grandes incisões (lâminas nº 20, 21, 22, 23, 24, 25).…”