The Efficacy of a Thrombin-Based Hemostatic Agent in Unilateral Total Knee Arthroplasty

Kim, Hee Jin; Fraser, Michael R.; Kahn, Barbara; Lyman, Stephen; Figgie, Mark P.

doi:10.2106/jbjs.k.00531

Cited by 47 publications

(58 citation statements)

References 8 publications

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“…- 14 In the context of orthopedic surgery, and especially in knee surgeries , its effectiveness is still controversial , with few and limited studies on the subject. Kim et al 18 showed no significant differences using or not the product in unilateral knee arthroplasties. However, Comadoll et al 20 showed that the use of Floseal (r) can significantly reduce the postoperative hemoglobin level drop, although it has not cause differences in the rates of blood transfusions.…”

Section: Discussionmentioning

confidence: 96%

“…This compound has already made significant benefits to control bleeding in several medical applications, 11 - 14 including orthopedic surgery, 5 - 17 but has not proven to be particularly efficient in total knee arthroplasty 18 . The primary objective of this work is to assess whether hemostasis with electrocautery compared to Floseal (r) during primary total knee arthroplasty leads to different rates of perioperative bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

et al. 2013

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Objective To evaluate whether hemostasis with eletrocauterization in comparison with Floseal(r) leads to different bleeding rates during total knee arthroplasty. Methods A comparative study was performed between two groups: group with ten consecutive total knee arthroplasties with Floseal(r) used as hemostatic method and control group with ten consecutive total knee arthroplasties with eletrocauterization as hemostatic method. Bleeding parameters such as debit of the drain, liquid infusion and blood transfusion rate were recorded. Results Floseal(r) group received less blood transfusion, less liquid infusion and lower drainage in absolute numbers compared to the control group. However, no parameter was statistically significant. Conclusion Hemostasis with Floseal(r) is as effective as hemostasis with eletrocauterization, what makes it a viable alternative to patients with contraindication to electric scalpel use. Level of Evidence II, Prospective Comparative Study.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

et al. 2013

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“…Randomization was determined before surgery through a sealed opaque envelope system (''Yes'': Evicel, ''No'': control group [8]. Envelopes were opened after the cementing of components.…”

Section: Methodsmentioning

confidence: 99%

“…For calculation of sample size, the following inputs were used as described in an earlier study [8]: 80% power, a critical p value of 0.05, and a mean difference and SD of 150 ± 350 mL of drain output. A sample size of 98 subjects per group was calculated to give a post hoc power of 85% to detect differences in drainage.…”

Section: Methodsmentioning

confidence: 99%

“…The use of plasma proteins at the site of the injury was described in the beginning of the last century in the German literature [2], and some early experience with fibrin sealants was reported during World War II [5]. Efforts have been made to use hemostatic agents such as thrombin-based sealants intraoperatively to minimize blood loss and decrease transfusion rates with little success [8]. Systemic tranexamic acid may be a more effective approach [7] but may also be associated with some risks, although recent systematic reviews have failed to demonstrate any difference in adverse events associated with the use of tranexemic acid [1,19].…”

Section: Introductionmentioning

confidence: 99%

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Intraarticular Fibrinogen Does Not Reduce Blood Loss in TKA: A Randomized Clinical Trial

Heyse

Haas

Drinkwater

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Bleeding remains an ongoing concern after total knee arthroplasty (TKA). Intraarticular application of human fibrinogen with a topical thrombin has been described to stop diffuse bleeding in knee arthroplasty. Questions/purposes It was hypothesized that the use of human fibrinogen as a topical agent would result in a reduction of bleeding and transfusions required after TKA; secondary end points included comparison of early clinical results including pain scores and range of motion (ROM) at 6 weeks and complications after surgery.

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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The Efficacy of a Thrombin-Based Hemostatic Agent in Unilateral Total Knee Arthroplasty

Cited by 47 publications

References 8 publications

Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

Comparação entre Floseal® e eletrocauterio na hemostasia após artroplastia total do joelho

Intraarticular Fibrinogen Does Not Reduce Blood Loss in TKA: A Randomized Clinical Trial

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

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