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Wang D, Wang HY, Luo ZY, Meng WK, Pei FX, Li Q, Zhou ZK, Zeng WN. Blood-conserving efficacy of multiple doses of oral tranexamic acid associated with an enhanced-recovery programme in primary total knee arthroplasty: a randomized controlled trial. Bone Joint J 2018; 100-B:1025-1032. [PMID: 30062946 DOI: 10.1302/0301-620x.100b8.bjj-2017-1598.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Aims The aim of this study was to identify the most effective regimen of multiple doses of oral tranexamic acid (TXA) in achieving maximum reduction of blood loss in total knee arthroplasty (TKA). Patients and Methods In this randomized controlled trial, 200 patients were randomized to receive a single dose of 2.0 g of TXA orally two hours preoperatively (group A), a single dose of TXA followed by 1.0 g orally three hours postoperatively (group B), a single dose of TXA followed by 1.0 g three and nine hours postoperatively (group C), or a single dose of TXA followed by 1.0 g orally three, nine, and 15 hours postoperatively (group D). All patients followed a routine enhanced-recovery protocol. The primary outcome measure was the total blood loss. Secondary outcome measures were hidden blood loss (HBL), reduction in the level of haemoglobin, the rate of transfusion and adverse events. Results Groups C (661.1 ml, sd 262.4) and D (597.7 ml, sd 219.6) had significantly lower mean total blood loss compared with groups A and B. The mean HBL was significantly lower in groups B (699.2 ml), C (533.1 ml) and D (469.9 ml) than in group A (p = 0.006, p < 0.001, and p < 0.001, respectively). Groups C (2.22 ml, sd 0.91) and D (2.04 ml, sd 0.95) had a lower reduction in the level of haemoglobin than groups A and B. However, there were no differences between groups C and D in relation to the three parameters. Conclusion The addition of two or three postoperative doses of TXA to one preoperative dose produced a significant reduction in blood loss. The two-dose postoperative regimen is the least necessary regimen for clinical efficacy in primary unilateral TKA. The three-dose regimen produced maximum reduction of blood loss. Cite this article: Bone Joint J 2018;100-B:1025–32.
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Affiliation(s)
- D. Wang
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - H-Y. Wang
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Z-Y. Luo
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - W-K. Meng
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - F-X. Pei
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Q. Li
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Z-K. Zhou
- Department of Orthopedics, West China
Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - W-N. Zeng
- Center for Joint Surgery, Southwest Hospital,
Third Military Medical University, Chongqing, China
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Pontone S, Brouard N, Moulin J, Desmonts JM. [Increasing shortage of anesthesiologists in France: how many are needed and when?]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1991; 10:362-78. [PMID: 1928859 DOI: 10.1016/s0750-7658(05)80813-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- S Pontone
- Département d'Anesthésie-Réanimation, Hôpital Bichat, Paris
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