Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/5ef606c80e88251166e5dce5
Brazilian Journal of Anesthesiology
Clinical Research

Efficacy of different doses and timing of tranexamic acid in major orthopedic surgeries: a randomized trial

Eficácia de diferentes doses e esquemas de administração de ácido tranexâmico em cirurgias ortopédicas de grande porte: estudo randomizado

Ravi Saravanan, Rajagopalan Venkatraman, Krishnamoorthy Karthik, Anand Pushparani

Downloads: 3
Views: 102

Abstract

Background
Tranexamic acid was studied in four different dosage regimens and their efficacy was compared for perioperative blood loss reduction, blood transfusion requirements and deep vein thrombosis (DVT) complication.

Methods
Two hundred patients undergoing major orthopedic procedures were divided into five groups containing 40 each: Placebo, low dose (bolus 10 mg.kg-1), low dose + maintenance (bolus 10 mg.kg-1 + maintenance 1 mg.kg-1.hr-1), high dose (bolus 30 mg.kg-1) and high dose + maintenance (bolus 30 mg.kg-1 + maintenance 3 mg.kg-1.hr-1). Surgical blood loss was measured intraoperatively and drains collection in the first 24 hr postoperative period. Blood transfusion was done when hematocrit falls less than 25%. DVT screening was done in the postoperative period.

Results
The intraoperative blood loss was 440 ± 207.54 mL in the placebo group, 412.5 ± 208.21 mL in the low dose group, 290 ± 149.6 ml in the low dose plus maintenance group, 332.5 ± 162.33 mL in the high dose group and 240.7 ± 88.15 mL in the high dose maintenance group (p < 0.001). The reduction in postoperative blood loss in the drain for first 24 hours was 80 ± 44.44 mL in the placebo group, 89.88 ± 44.87 mL in the low dose group, 56.7 ± 29.12 mL in the low dose plus maintenance group, 77.9 ± 35.74 mL in the high dose group and 46.7 ± 19.9 mL in the high dose maintenance group (p < 0.001). DVT was not encountered in any patient.

Conclusion
Tranexamic acid was most effective in reducing surgical blood loss and blood transfusion requirements in a low dose + maintenance group.

Keywords

Blood loss;  Blood transfusion;  Dosage;  Timing;  Tranexamic acid

Resumo

Justificativa
O ácido tranexâmico foi avaliado em quatro esquemas com diferentes posologias, comparando-se a eficácia de cada esquema quanto à redução na perda sanguínea perioperatória, necessidade de transfusão sanguínea e ocorrência de Trombose Venosa Profunda (TVP).

Método
Duzentos pacientes submetidos a procedimentos ortopédicos de grande porte foram divididos em cinco grupos de 40 pacientes de acordo com o esquema de administração de ácido tranexâmico: grupo placebo, grupo baixa dose (bolus de 10 mg.kg-1), grupo baixa dose e manutenção (bolus de 10 mg.kg-1 + manutenção de 1 mg.kg-1.h-1), grupo alta dose (bolus de 30 mg.kg-1), e grupo alta dose e manutenção (bolus de 30 mg.kg-1 + manutenção de 3 mg.kg-1.h-1). A perda sanguínea cirúrgica foi medida no intraoperatório. Além disso, nas primeiras 24 horas pós-operatórias foi medido o volume de sangue coletado no dreno. Era realizada transfusão de sangue se o valor do hematócrito fosse inferior a 25%. Foi realizada avaliação quanto à ocorrência de TVP no pós-operatório.

Resultados
A perda sanguínea intraoperatória foi de 440 ± 207,54 mL no grupo placebo, 412,5 ± 208,21 mL no grupo baixa dose, 290 ± 149,6 mL no grupo baixa dose e manutenção, 332,5 ± 162,33 mL no grupo alta dose, e 240,7 ± 88,15 mL no grupo alta dose e manutenção (p < 0,001). A redução na perda sanguínea pós-operatória pelo dreno nas primeiras 24 horas foi de 80 ± 44,44 mL no grupo placebo; 89,88 ± 44,87 mL no grupo baixa dose, 56,7 ± 29,12 mL no grupo baixa dose e dose de manutenção, 77,9 ± 35,74 mL no grupo alta dose, e 46,7 ± 19,9 mL no grupo alta dose e manutenção (p < 0,001). TVP não foi observada em nenhum paciente.

Conclusão
O ácido tranexâmico administrado em baixa dose combinado à manutenção foi mais eficaz em reduzir a perda sanguínea cirúrgica e a necessidade de transfusão de sangue

Palavras-chave

Perda sanguínea;  Transfusão de sangue;  Dosagem;  Posologia;  Ácido tranexâmico

References

1. Irisson E, Hémon Y, Pauly V, Parratte S, Argenson JN, Kerbaul F. Tranexamic acid reduces blood loss and financial cost in primary total hip and knee replacement surgery. Orthop Traumatol Surg Res. 2012;98:477-83.

2. Ker K, Edwards P, Perel P, Shakur H, Roberts I. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ. 2012;344:e3054.

3. Zufferey PJ, Lanoiselée J, Chapelle C, et al.; investigators of the PeriOpeRative Tranexamic acid in hip arthroplasty (PORTO) Study. Intravenous tranexamic acid bolus plus infusion is not more effective than a single bolus in primary hip arthroplasty: a randomized controlled trial. Anesthesiology. 2017;127:413-22.

4. Aytuluk HG, Yaka HO. Tranexamic acid is effective in lower doses with infusion in total knee arthroplasty. Acta Orthop Traumatol Turc. 2019;53:81-5.

5. Maniar RN, Kumar G, Nayak RM. Most effective regimen of tranexamic acid in knee arthroplasty ‒ a prospective randomized controlled study in 240 patients. Clin Orthop Relat Res. 2012;470:2605-12.

6. McHugh SM, Kolarczyk L, Lang RS, Wei LM, Jose M, Subramaniam K. A comparison of high-dose and low-dose tranexamic acid antifibrinolytic protocols for primary coronary artery bypass surgery. Indian J Anaesth. 2016;60:94-101.

7. Zimmerman LH. Causes and consequences of critical bleeding and mechanisms of blood coagulation. Pharmacotherapy. 2007;27:45-56.

8. Thipparampall AK, Gurajala I, Gopinath R. The effect of different dose regimens of tranexamic acid in reducing blood loss during hip surgery. Indian J Anaesth. 2017;61:235-9.

9. Goobie SM, Meier PM, Pereira LM, et al. Efficacy of tranexamic acid in pediatric craniosynostosis surgery: A double-blind, placebo-controlled trial. Anesthesiology. 2011;114:862-71.

10. Thiagarajamurthy S, Levine A, Dunning J. Does prophylactic tranexamic acid safely reduce bleeding without increasing thrombotic complications in patients undergoing cardiac surgery? Interact Cardiovasc Thorac Surg. 2004;3:489-94.

11. Fawzy H, Elmistekawy E, Bonneau D, Latter D, Errett L. Can local application of Tranexamic acid reduce post-coronary bypass surgery blood loss? A randomized controlled trial. J Cardiothorac Surg. 2009;4:25.

12. Choi WS, Irwin MG, Samman N. The effect of tranexamic acid on blood loss during orthognathic surgery: A randomized controlled trial. J Oral Maxillofac Surg. 2009;67:125-33.

13. Ho KM, Ismail H. Use of intravenous tranexamic acid to reduce allogeneic blood transfusion in total hip and knee arthroplasty: a meta-analysis. Anaesth Intensive Care. 2003;31:529-37.

14. Gill JB, Chin Y, Levin A, Feng D. The use of antifibrinolytic agents in spine surgery. A meta-analysis. J Bone Joint Surg Am. 2008;90:2399-407.

15. Huang F, Wu D, Ma G, Yin Z, Wang Q. The use of tranexamic acid to reduce blood loss and transfusion in major orthopaedic surgery: a meta-analysis. J Surg Res. 2014;186:318-27.

5ef606c80e88251166e5dce5 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections