Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.02.011
Brazilian Journal of Anesthesiology
Original Investigation

Tranexamic acid in total shoulder arthroplasty under regional anesthesia: a randomized, single blinded, controlled trial

Ácido tranexâmico na artroplastia total do ombro sob anestesia regional: um estudo randomizado, simplescego e controlado

Teresa Garcia, Mariana Fragão-Marques, Pedro Pimentão, Martim Pinto, Inês Pedro, Carlos Martins

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Abstract

Purpose
The purpose of this study was to determine whether Tranexamic Acid (TXA) can significantly reduce perioperative blood loss in Total Shoulder Arthroplasty (TSA) performed under regional anesthesia.

Methods
We performed a randomized, single blinded, controlled study. Forty-five patients were submitted to TSA under regional anesthesia to treat cuff tear arthropathy, proximal humeral fractures, chronic instability, primary osteoarthrosis, and failures of previous prosthesis. Patients were randomized to either group TXA therapy (TXA), with 1 g Intravenous (IV), or no Intervention (NTXA). Postoperative total drain output, hemoglobin variation, total blood loss, hemoglobin loss, and need for transfusion were measured. Pain-related variables were also assessed: postoperative pain assessment by visual analog scale, inpatient pain breakthrough, quality of recovery, length of stay, and coagulation function testing.

Results
Participants presented a mean age of 76-years, 15.6% were male, 82.2% were American Society of Anesthesiologists (ASA) physical status 1 or 2. There were no differences between groups concerning transfusions, operative time, Post-Anesthesia Care Unit (PACU) length of stay and in-hospital stay, and QoR-15 or postoperative pain. Bleeding measured by drain output at 2, 24 and 48 hours was significantly less in the TXA group at each timepoint. There was a difference in Hb variation – TXA: median (IQR) -1.4 (1.3) g.dL-1 vs. NTXA: -2.2 (1.3) g.dL-1; median difference: 0.80 (0.00–1.20); p =  0.047. aPTT was lower in TXA administered patients – TXA: median (IQR) 29.6 (14.0)s vs. NTXA: 33 (5.8)s; difference in medians: -4.00 (-6.50–-1.00); p =  0.012.

Conclusion
TXA use significantly decreased blood loss measured by drain output and Hb drop in TSA under regional anesthesia.

Keywords

Total shoulder replacement;  Tranexamic acid; Surgical blood loss;  Blood transfusion

Resumo

Objetivo: O objetivo deste estudo foi determinar se o ácido tranexâmico (TXA) pode reduzir significativamente a perda sanguínea perioperatória na artroplastia total do ombro (TSA) realizada sob anestesia regional. Métodos: Realizamos um estudo randomizado, cego e controlado. Quarenta e cinco pacientes foram submetidos a TSA sob anestesia regional para tratar artropatia de ruptura do manguito, fraturas proximais do úmero, instabilidade crônica, osteoartrose primária e falhas de próteses anteriores. ), ou nenhuma intervenção (NTXA). O débito total do dreno pós-operatório, a variação de hemoglobina, a perda total de sangue, a perda de hemoglobina e a necessidade de transfusão foram medidos. As variáveis relacionadas à dor também foram avaliadas: avaliação da dor pós-operatória por escala visual analógica, avanço da dor do paciente internado, qualidade da recuperação, tempo de internação e teste de função de coagulação. Resultados: Os participantes apresentaram idade média de 76 anos, 15,6% eram do sexo masculino, 82,2% eram estado físico 1 ou 2 da American Society of Anesthesiologists (ASA). Não houve diferenças entre os grupos quanto às transfusões, tempo operatório, tempo na Sala de Recuperação Pós-anestésica (SRPA) de permanência e internamento e QoR-15 ou dor pós-operatória. O sangramento medido pela saída do dreno em 2, 24 e 48 horas foi significativamente menor no grupo TXA em cada ponto de tempo. Houve uma diferença na variação de Hb-TXA: mediana (IQR) -1,4(1,3) g/dL vs NTXA: -2,2 ( 1,3) g/dL; diferença mediana: 0,80 [0,00–1,20]; p=0,047.aPTT foi menor em pacientes administrados com TXA (TXA: mediana (IQR) 29,6 (14,0) s vs.NTXA: 33 (5,8) s; diferença nas medianas: -4,00 [-6,50 - -1,00]; p=0,012 ). Conclusão: O uso de TXA diminuiu significativamente a perda sanguínea medida pelo débito do dreno e queda de Hb na TSA sob anestesia regional.

Palavras-chave

Substituição total do ombro; Ácido tranexâmico; Perda sanguínea cirúrgica; Transfusão de sangue.

References

1 A.D. Vara, D.M. Koueiter, D.E. Pinkas, et al. Intravenous tranexamic acid reduces total blood loss in reverse total shoulder arthroplasty: a prospective, double-blinded, randomized, controlled trial J Shoulder Elb Surg, 26 (2017), pp. 1383-1389

2 R. Gillespie, Y. Shishani, S. Joseph, et al. Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty J Shoulder Elb Surg, 24 (2015), pp. 1679-1684

3 L. Pauzenberger, M.A. Domej, P.R. Heuberer, et al. The effect of intravenous tranexamic acid on blood loss and early post-operative pain in total shoulder arthroplasty Bone Joint J, 99-B (2017), pp. 1073-1079

4 B.-F. Yu, G.-J. Yang, Q. Li, et al. Tranexamic acid decreases blood loss in shoulder arthroplasty: A meta-analysis Medicine (Baltimore), 96 (2017), p. e7762

5 G.L. Cvetanovich, Y.A. Fillingham, M. O’Brien, et al. Tranexamic acid reduces blood loss after primary shoulder arthroplasty: a double-blind, placebo-controlled, prospective, randomized controlled trial JSES Open Access, 2 (2018), pp. 23-27

6 J. Gilbody, H.S. Dhotar, A.V. Perruccio, et al. Topical tranexamic acid reduces transfusion rates in total hip and knee arthroplasty J Arthroplasty, 29 (2014), pp. 681-684

7 L.-T. Kuo, W.-H. Hsu, C.-C. Chi, et al. Tranexamic acid in total shoulder arthroplasty and reverse shoulder arthroplasty: a systematic review and meta-analysis BMC Musculoskelet Disord, 19 (2018), p. 60

8 K.I. Gruson, K.J. Accousti, B.O. Parsons, et al. Transfusion after shoulder arthroplasty: An analysis of rates and risk factors J Shoulder Elb Surg, 18 (2009), pp. 225-230

9 K. Ker, D. Prieto-Merino, I. Roberts Systematic review, meta-analysis, and meta-regression of the effect of tranexamic acid on surgical blood loss Br J Surg, 100 (2013), pp. 1271-1279

10 C.J. Dunn, K.L. Goa Tranexamic acid: a review of its use in surgery and other indications Drugs, 57 (1999), pp. 1005-1032

11 C.-X. Sun, L. Zhang, L.-D. Mi, et al. Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty: A systematic review and meta-analysis Medicine (Baltimore), 96 (2017), p. e7015

12 R.J. Friedman, E. Gordon, R.B. Butler, et al. Tranexamic acid decreases blood loss after total shoulder arthroplasty J Shoulder Elb Surg, 25 (2016), pp. 614-618

13 C.-H. Chang, Y. Chang, D.W. Chen, et al. Topical tranexamic acid reduces blood loss and transfusion rates associated with primary total hip arthroplasty Clin Orthop Relat Res, 472 (2014), pp. 1552-1557

14 Y.K. Kagoma, M.A. Crowther, J. Douketis, et al. Use of antifibrinolytic therapy to reduce transfusion in patients undergoing orthopedic surgery: A systematic review of randomized trials Thromb Res, 123 (2009), pp. 687-696

15 J.M. Kirsch, A. Bedi, N. Horner, et al. Tranexamic acid in shoulder arthroplasty JBJS Rev, 5 (2017), p. e3

16 S. De Hert, S. Staender, G. Fritsch, et al. Pre-operative evaluation of adults undergoing elective noncardiac surgery Eur J Anaesthesiol, 35 (2018), pp. 407-465

17 WHO Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity, WHO (2018)

18 S.B. Nadler, J.H. Hidalgo, T. Bloch Prediction of blood volume in normal human adults Surgery, 51 (1962), pp. 224-232

19 L. Good, E. Peterson, B. Lisander Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement Br J Anaesth, 90 (2003), pp. 596-599

20 J. Kleif, J. Waage, KB Christensen, et al. Systematic review of the QoR-15 score, a patient reported outcome measure measuring quality of recovery after surgery and anaesthesia Br J Anaesth [Internet], 120 (2018), pp. 28-36 Available from: http://www.ncbi.nlm.nih.gov/pubmed/29397134. Jan 1 [cited 2019 Sep 28]

21 J.T. Abildgaard, R. McLemore, S.J. Hattrup Tranexamic acid decreases blood loss in total shoulder arthroplasty and reverse total shoulder arthroplasty J Shoulder Elb Surg, 25 (2016), pp. 1643-1648

22 S.H. Kim, W.I. Jung, Y.J. Kim, et al. Effect of Tranexamic Acid on Hematologic Values and Blood Loss in Reverse Total Shoulder Arthroplasty Biomed Res Int, 2017 (2017), Article 9590803

23 J. He, X. Wang, G.-H. Yuan, et al. The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty Medicine (Baltimore), 96 (2017), p. e7880

24 F. Liu, D. Xu, K. Zhang, et al. Effects of tranexamic acid on coagulation indexes of patients undergoing heart valve replacement surgery under cardiopulmonary bypass Int J Immunopathol Pharmacol, 29 (2016), pp. 753-758

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