Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla / Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement

Objetivo. Evaluar la eficacia y seguridad de la administración de una dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla. Material y métodos. Estudio observacional prospectivo de la administración de ácido tranexámico en pacientes intervenidos de prótesis total primaria de rodilla desde noviembre de 2013 a febrero de 2015, en los que se utilizó un sistema de recuperación de sangre autóloga. Se incluyeron en el estudio 98 pacientes distribuidos en dos grupos de 49 pacientes según la exposición a la administración de ácido tranexámico. La variable principal del estudio fue el número de pacientes que precisaron autotransfusión del sistema de recuperación de sangre autológa. Resultados. No se registraron pérdidas durante el seguimiento. No hubo diferencias significativas entre ambos grupos con respecto a las variables preoperatorias y hospitalarias. Los valores medios de hemoglobina y hematocrito preoperatorios, a las 24 y 48 h postoperatorias eran similares en ambos grupos. El volumen medio de sangrado en el sistema de recuperación de sangre autóloga y la pérdida media estimada de sangre fue menor en los pacientes a los que se había administrado ácido tranexámico, siendo las diferencias significativas. Ningún paciente del grupo en el que se administró ácido tranexámico precisó autotransfusión sanguínea. No se precisó alotransfusión sanguínea en los pacientes de la cohorte. No se registraron eventos adversos relacionados con la administración del ácido tranexámico. Conclusiones. El uso de una dosis única 15 mg/kg de ATX intravenoso en PTR primaria ha presentado una tasa de no autotransfusión ni alotranfusión sanguínea del 100%, sin aumento en la incidencia de eventos trombóticos. Por ello recomendamos su utilización en este grupo de pacientes, con una indicación que debe ser individualizada, justificar su uso en la historia clínica y precisar del consentimiento informado del paciente. Nivel de evidencia III (AU)

Objective. To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. Materials and methods. Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. Results. No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. Conclusions. Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory (AU)

[Single intravenous tranexamic acid dose to reduce blood loss in primary total knee replacement]. / Dosis única intravenosa de ácido tranexámico como medida de ahorro transfusional en prótesis total primaria de rodilla.

OBJECTIVE: To evaluate the effectiveness and safety of a single intravenous dose of tranexamic acid in order to reduce blood loss in total knee replacement. MATERIALS AND METHODS: Prospective observational study of the administration of tranexamic acid in patients undergoing primary total knee arthroplasty from November 2013 to February 2015, in which an autologous blood recovery system was used. The study included 98 patients, distributed into two groups of 49 patients according to whether or not they received intravenous tranexamic acid. The primary endpoint was the number of patients requiring autologous transfusion from the recovery system autologous blood recovery system. RESULTS: No drop-outs were recorded during follow-up. There were no significant differences between groups as regards the preoperative and hospital variables. The mean preoperative haemoglobin and haematocrit at 24 and 48 hours postoperatively were similar in both groups. The average volume of bleeding in the autologous blood recovery system and estimated average blood loss was lower in patients who had been administered tranexamic acid, with significant differences. No patients in the group that was administered tranexamic acid required blood autotransfusion. The transfusion rate was zero in the two groups. No adverse events related to the administration of tranexamic acid were recorded. CONCLUSIONS: Intravenous administration of tranexamic acid, according to the described protocol, has presented a non-autotransfusion or allo-transfusion rate of 100%, with no increased incidence of thrombotic events. Thus, its use in this group of patients is recommended. The indication should be individualized, its use justified in the patient medical records, and informed consent is mandatory.