Results after the application of tranexamic acid intravenous or intra-articular in the control of postsurgical bleeding after total hip arthroplasty: a randomized controlled trial.

INTRODUCTION: A frequent complication after total hip arthroplasty is bleeding; to reduce it, intravenous or intra-articular tranexamic acid (TXA) is used. There is no evidence yet on which route of administration is better. MATERIALS AND METHOD: This was a prospective, controlled, randomized study in 2 arms between February 2017 and February 2019. In group A, 15 mg/kg intravenous TXA was administered and in group B 2 g intra-articular TXA. Haemoglobin and haematocrit values were evaluated at 24-72 h, also volume of drained blood, volume of blood lost, transfusions and complications. RESULTS: A total of 195 patients were included: 110 in group A and 85 group B. Haemoglobin dropped 3.10 ± 1.32 g/dl in 24 h and 3.63 ± 1.41 g/dl at 72 h in group A; the haematocrit dropped 8.38 ± 4.67% in 24 h and 15.40 ± 4.39% in 72 h. In group B, haemoglobin dropped 3.09 ± 1.40 g/dl in 24 h and 3.34 ± 1.23 g/dl in 72 h and haematocrit 9.75 ± 3.95% and 10.40 ± 3.72% in 24 and 72 h. No significant differences were found for haemoglobin values at 24 and 72 h and haematocrit at 24 h (p > 0.05); we did not obtain statistically significant differences in drainage, blood loss between groups or in the proportion of transfused. When stratifying the results by age, we obtained significant differences in the decrease in haemoglobin (p = 0.021) and haematocrit (p = 0.025) in patients > 65 years. CONCLUSIONS: The different routes of administration of TXA in PTC have a similar effect in reducing post-operative bleeding without evidencing an increase in complications. LEVEL OF EVIDENCE: I.

Hematoma espinal epidural espontáneo asociado a tratamiento anticoagulante con acenocumarol: a propósito de un caso / Spontaneous spinal epidural hematoma in patients treated with acenocumarol. A case study

El hematoma epidural espontáneo es una entidad muy poco frecuente que supone una urgencia neurológica. Su presentación es muy variable, desde un dolor de espalda hasta una tetraplejia, según la gravedad y el nivel de compresión. Se comunica el caso de un paciente cardiópata de 71 años, tratado con acenocumarol, que presentó un hematoma epidural de modo espontáneo. Al inclinarse hacia el suelo, el paciente, que no tenía síntomas, sufrió un dolor brusco cervical seguido de debilidad en los miembros superiores e inferiores. Ante la sospecha clínica de una compresión medular, se decide realizar una resonancia magnética de urgencia, que mostró un hematoma de localización epidural con extensión desde C4 hasta T8. El diagnóstico urgente y el tratamiento de descompresión precoz son fundamentales para reducir al mínimo los daños neurológicos posteriores permanentes. Nivel de Evidencia: IV

Spontaneous spinal epidural hematoma is an uncommon condition and a neurological emergency. The clinical presentation of this type of hematoma is very variable, ranging from a backache up to a quadriplegia, according to the severity and the site of compression. Here, we discuss the clinical case of a 71-year-old patient with heart problems, under previous treatment with acenocumarol, that suffered a spontaneous epidural hematoma. The patient, previously asymptomatic, presented, sudden cervical pain when he bent over, followed by weakness in the lower and the upper limbs. Due to the clinical suspicion, an emergency MRI was performed, showing an epidural hematoma extending from C4 to T8. Early diagnosis and decompressive treatment are mandatory to minimize permanent neurological damage. Level of Evidence: IV