[Effectiveness of tranexamic acid in routine performance of total knee replacement surgery]. / Efectividad de ácido tranexámico en prótesis total de rodilla en la práctica clínica habitual.

OBJECTIVES: To evaluate the effectiveness of treatment with tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion rates and the number of units of packed red blood cells required in patients undergoing total knee replacement surgery. MATERIAL AND METHODS: We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006. Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin and hematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packed red blood cells administered, and whether or not drains were clamped within 4 hours. Complications attributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded. RESULTS: Data for 166 patients were analyzed. Of these, 120 (72.3%) received tranexamic acid, 15 (9%) received epsilon-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to 17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (133%) had received epsilon-aminocaproic acid, and 9 (29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfused in each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the epsilon-aminocaproic acid group, and 0.645 in the group with no antifibrinolytic treatment (P < .001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the epsilon-aminocaproic acid group and 3.76 g/dL in the group with no antifibrinolytic treatment (P < .001). CONCLUSIONS: Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and in the number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found.

Efectividad de ácido tranexámico en prótesis total de rodilla en la práctica clínica habitual / Effectiveness of tranexamic acid in routine performance of total knee replacement surgery

OBJETIVOS: Evaluar la efectividad en la práctica clínica habitual del tratamiento con ácido tranexámico (TRAN) versus no antifibrinolíticos (NA) en la disminución de la tasa de transfusiones y unidades de concentradosde hematíes (CH) requeridas en pacientes intervenidosde prótesis total de rodilla (PTR).MATERIAL Y MÉTODO: Se revisaron las historias clínicas de todos los pacientes intervenidos de PTR primaria en un hospital general durante el año 2006. Se registró: tratamiento con TRAN, utilización de otros antifibrinolíticos(AF), hemoglobina (Hb) y hematocrito (Hto) preoperatorios y al 3er día postoperatorio (p.o.), pacientestrasfundidos, unidades de CH administradas, y si se realizóo no el clampaje de los drenajes durante las primeras 4 horas del p.o. También se registraron las complicacionesrelacionables con TRAN (tromboembólicas y/o sistémicas) y tratamiento preoperatorio con eritropoyetina (rhEPO).RESULTADOS: Se analizaron los datos de 166 pacientes. De éstos, 120 (72,3%) recibieron TRAN, 15 (9%) recibieron ácido épsilon-aminocaproico (EACA), y 31 (18,7%) no recibieron AF (NA). En total se transfundieron17 (10,2%) pacientes, de los cuales 6 en TRAN (5,0%), 2 en EACA (13,3%), y 9 en NA (29,0%) (p<0,001). La media de CH transfundidas en cada grupofue de 0,075 en TRAN, 0,200 en EACA, y 0,645 en NA (p<0,001). El descenso medio de la Hb al quinto día p.o.fue de 3,04 g/dl en TRAN, 3,55 en EACA, y 3,76 en NA (p=0,016).CONCLUSIONES: El TRAN es efectivo en la reducción del porcentaje de pacientes transfundidos y de CH administradosen PTR. No se encontró ninguna complicación relacionada con este tratamiento (AU)

OBJETIVOS: To evaluate the effectiveness of treatmentwith tranexamic acid, compared to absence of antifibrinolytic treatment, in reducing transfusion ratesand the number of units of packed red blood cells required in patients undergoing total knee replacement surgery.MATERIAL AND METHODS: We reviewed the medical records of all patients who underwent total knee replacement surgery in a general hospital in 2006.Information was recorded on treatment with tranexamic acid, use of other antifibrinolytic drugs, hemoglobin andhematocrit levels before surgery and 3 days after surgery, patients requiring transfusions, units of packedred blood cells administered, and whether or not drains were clamped within 4 hours. Complicationsattributable to tranexamic acid (thromboembolic or systemic complications) and preoperative treatment with erythropoietin were also recorded.RESULTS: Data for 166 patients were analyzed. Ofthese, 120 (72.3%) received tranexamic acid, 15 (9%)received å-aminocaproic acid, and 31 (18.7%) received no antifibrinolytic treatment. Transfusions were given to17 patients, of whom 6 (5.0%) had received tranexamic acid, 2 (13.3%) had received å-aminocaproic acid, and 9(29.0%) had received no antifibrinolytic treatment. The mean numbers of packed red blood cell units transfusedin each group were as follows: 0.075 in the tranexamic acid group, 0.200 in the å-aminocaproic acid group, and0.645 in the group with no antifibrinolytic treatment (P<.001). The mean decrease in hemoglobin levels 5 days after surgery was 3.04 g/dL in the tranexamic acid group, 3.55 g/dL in the å-aminocaproic acid group and 3.76 g/dLin the group with no antifibrinolytic treatment (P<.001).CONCLUSIONS: Tranexamic acid is effective in reducing the percentage of patients requiring transfusions and inthe number of units of packed red blood cells required in total knee replacement surgery. No complications attributable to this treatment were found (AU)