Optimal Route for Tranexamic Acid in Diabetics and Obese Patients Undergoing Primary Total Knee Arthroplasty – a Data from Randomized Study

Kód výsledku v IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F61989592%3A15110%2F20%3A73603204" target="_blank" >RIV/61989592:15110/20:73603204 - isvavai.cz</a>

Nalezeny alternativní kódy

RIV/00098892:_____/20:N0000116

Výsledek na webu

<a href="http://www.achot.cz/detail.php?stat=1168" target="_blank" >http://www.achot.cz/detail.php?stat=1168</a>

DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Optimal Route for Tranexamic Acid in Diabetics and Obese Patients Undergoing Primary Total Knee Arthroplasty – a Data from Randomized Study

Popis výsledku v původním jazyce

PURPOSE OF THE STUDY To determine the optimal strategy for tranexamic acid (TXA) administration in diabetic patients, smokers and obese patients (BMI &gt; 30 kg/m2) undergoing primary total knee arthroplasty (TKA). MATERIAL AND METHODS The total of 400 consecutive patients indicated for primary TKA were randomised into 4 basic groups with different TXA administration regimens. Group 1 (IV1) had a single intravenous dose (15 mg TXA/kg) applied prior to skin incision. Group 2 (IV2) got two intravenous doses (15 mg TXA/kg): one prior to skin incision and one subsequently 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 ml of saline irrigated topically at the end of the surgery. Group 4 (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Follow-up period was one year postoperatively. RESULTS In the group of diabetic patients (n = 87; 21.7%) the lowest TBL was observed in the order: IV1, IV2 &gt; COMB &gt; TOP. In the obese patients (BMI &gt; 30 kg/m2; n = 242; 60.5%), TBL was significantly lower in the intravenous regimens (IV1: p = 0.002; IV2: p = 0.005, respectively) than in the TOP regimen. In the smoking patients (n = 30; 7.5%), TBLs were significantly lower in the order: IV1 &gt; IV2 &gt; COMB &gt; TOP. DISCUSSION Individualised approach to prevention and therapy is a recent trend, also because comorbidities significantly affect the result of the intervention. In the case of diabetes, obesity and smoking, there is a proven link to early post-operative infections, mainly due to poorer innate immunity. It is conceivable, though, that the occurrence of infectious complications is also contributed to by larger hematomas or hemarthroses which are largely preventable. CONCLUSIONS In the diabetic and obese patients (BMI &gt; 30 kg/m2), the combined topical/intravenous TXA application and two intravenous doses of TXA interventions were shown to be the most effective. However, no evidence of superiority of any of the TXA administration routes was obtained in the smokers. None of the TXA protocols was associated with a higher incidence of complications or early reoperation following TKA surgery.

Název v anglickém jazyce

Optimal Route for Tranexamic Acid in Diabetics and Obese Patients Undergoing Primary Total Knee Arthroplasty – a Data from Randomized Study

Popis výsledku anglicky

PURPOSE OF THE STUDY To determine the optimal strategy for tranexamic acid (TXA) administration in diabetic patients, smokers and obese patients (BMI &gt; 30 kg/m2) undergoing primary total knee arthroplasty (TKA). MATERIAL AND METHODS The total of 400 consecutive patients indicated for primary TKA were randomised into 4 basic groups with different TXA administration regimens. Group 1 (IV1) had a single intravenous dose (15 mg TXA/kg) applied prior to skin incision. Group 2 (IV2) got two intravenous doses (15 mg TXA/kg): one prior to skin incision and one subsequently 6 hours after the first dose. Group 3 (TOP) had 2 g TXA in 50 ml of saline irrigated topically at the end of the surgery. Group 4 (COMB) combined IV1 and TOP regimens. We monitored the amount of total blood loss (TBL), haemoglobin drop, use of blood transfusions (BTs), and complications in each patient. Follow-up period was one year postoperatively. RESULTS In the group of diabetic patients (n = 87; 21.7%) the lowest TBL was observed in the order: IV1, IV2 &gt; COMB &gt; TOP. In the obese patients (BMI &gt; 30 kg/m2; n = 242; 60.5%), TBL was significantly lower in the intravenous regimens (IV1: p = 0.002; IV2: p = 0.005, respectively) than in the TOP regimen. In the smoking patients (n = 30; 7.5%), TBLs were significantly lower in the order: IV1 &gt; IV2 &gt; COMB &gt; TOP. DISCUSSION Individualised approach to prevention and therapy is a recent trend, also because comorbidities significantly affect the result of the intervention. In the case of diabetes, obesity and smoking, there is a proven link to early post-operative infections, mainly due to poorer innate immunity. It is conceivable, though, that the occurrence of infectious complications is also contributed to by larger hematomas or hemarthroses which are largely preventable. CONCLUSIONS In the diabetic and obese patients (BMI &gt; 30 kg/m2), the combined topical/intravenous TXA application and two intravenous doses of TXA interventions were shown to be the most effective. However, no evidence of superiority of any of the TXA administration routes was obtained in the smokers. None of the TXA protocols was associated with a higher incidence of complications or early reoperation following TKA surgery.

Druh

J_imp - Článek v periodiku v databázi Web of Science

CEP obor

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OECD FORD obor

30211 - Orthopaedics

Projekt

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Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2020

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Název periodika

Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca

ISSN

0001-5415

e-ISSN

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Svazek periodika

87

Číslo periodika v rámci svazku

6

Stát vydavatele periodika

CZ - Česká republika

Počet stran výsledku

9

Strana od-do

429-437

Kód UT WoS článku

000607450200008

EID výsledku v databázi Scopus

2-s2.0-85099568244