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Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty: A large, single-center, retrospective study.

Abstract Little has been published on blood management in total hip and knee arthroplasty (THA and TKA, respectively) patients focusing on both hematopoiesis and hemostasis. Our aim was to explore the effectiveness and safety of an optimized blood management program in THA and TKA patients in a large, single-center, retrospective study.We retrospectively reviewed consecutive primary unilateral THA and TKA patients' data at our institution through the National Health Database. They were divided into 3 groups according to an optimized blood management program: group A-combined use of intravenous and topical tranexamic acid (TXA); group B-use of recombinant human erythropoietin (rHuEPO) and iron supplements in addition to treatments in group A; group C-use of additional multiple boluses of TXA in addition to treatments in group B. The primary outcomes were hemoglobin (Hb) drop and calculated total blood loss (TBL). Other outcome measurements such as transfusion rate, postoperative length of stay (PLOS), venous thromboembolism (VTE), and mortality were also compared.From 2014 to 2016, a total of 1907 unilateral THA (986 in group A, 745 in group B, and 176 in group C) and 1505 unilateral TKA (795 in group A, 556 in group B, and 154 in group C) procedures were conducted at our institution. The Hb drop, calculated TBL, and PLOS in group C were significantly lower than those in groups A and B for THA and TKA patients. The transfusion rate in group C was also significantly less than in groups A and B for THA patients, while it was similar in groups A and B for TKA patients. No patients in group C received a transfusion. A significant difference was not detected in the incidence of deep vein thrombosis. No episode of symptomatic pulmonary embolism or all-cause mortality occurred within 30 days postoperatively.The current retrospective study suggests that for patients receiving primary unilateral THA or TKA, multiple boluses of intravenous TXA combined with topical TXA, rHuEPO, and iron supplements can reduce the calculated TBL, Hb drop, transfusion rate, and PLOS without increasing the incidence of VTE or mortality.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 29505518
OWN - NLM
STAT- MEDLINE
DCOM- 20180309
LR  - 20180309
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 1
DP  - 2018 Jan
TI  - Effectiveness and safety of an optimized blood management program in total hip
      and knee arthroplasty: A large, single-center, retrospective study.
PG  - e9429
LID - 10.1097/MD.0000000000009429 [doi]
AB  - Little has been published on blood management in total hip and knee arthroplasty 
      (THA and TKA, respectively) patients focusing on both hematopoiesis and
      hemostasis. Our aim was to explore the effectiveness and safety of an optimized
      blood management program in THA and TKA patients in a large, single-center,
      retrospective study.We retrospectively reviewed consecutive primary unilateral
      THA and TKA patients' data at our institution through the National Health
      Database. They were divided into 3 groups according to an optimized blood
      management program: group A-combined use of intravenous and topical tranexamic
      acid (TXA); group B-use of recombinant human erythropoietin (rHuEPO) and iron
      supplements in addition to treatments in group A; group C-use of additional
      multiple boluses of TXA in addition to treatments in group B. The primary
      outcomes were hemoglobin (Hb) drop and calculated total blood loss (TBL). Other
      outcome measurements such as transfusion rate, postoperative length of stay
      (PLOS), venous thromboembolism (VTE), and mortality were also compared.From 2014 
      to 2016, a total of 1907 unilateral THA (986 in group A, 745 in group B, and 176 
      in group C) and 1505 unilateral TKA (795 in group A, 556 in group B, and 154 in
      group C) procedures were conducted at our institution. The Hb drop, calculated
      TBL, and PLOS in group C were significantly lower than those in groups A and B
      for THA and TKA patients. The transfusion rate in group C was also significantly 
      less than in groups A and B for THA patients, while it was similar in groups A
      and B for TKA patients. No patients in group C received a transfusion. A
      significant difference was not detected in the incidence of deep vein thrombosis.
      No episode of symptomatic pulmonary embolism or all-cause mortality occurred
      within 30 days postoperatively.The current retrospective study suggests that for 
      patients receiving primary unilateral THA or TKA, multiple boluses of intravenous
      TXA combined with topical TXA, rHuEPO, and iron supplements can reduce the
      calculated TBL, Hb drop, transfusion rate, and PLOS without increasing the
      incidence of VTE or mortality.
CI  - Copyright (c) 2017 The Authors. Published by Wolters Kluwer Health, Inc. All
      rights reserved.
FAU - Zhang, Shaoyun
AU  - Zhang S
AD  - Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu,
      Sichuan, China.
FAU - Huang, Qiang
AU  - Huang Q
FAU - Xu, Bin
AU  - Xu B
FAU - Ma, Jun
AU  - Ma J
FAU - Cao, Guorui
AU  - Cao G
FAU - Pei, Fuxing
AU  - Pei F
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Antifibrinolytic Agents)
RN  - 0 (Recombinant Proteins)
RN  - 0 (Trace Elements)
RN  - 11096-26-7 (Erythropoietin)
RN  - 6T84R30KC1 (Tranexamic Acid)
RN  - E1UOL152H7 (Iron)
SB  - AIM
SB  - IM
MH  - Administration, Intravenous
MH  - Administration, Topical
MH  - Adult
MH  - Aged
MH  - Anemia/*drug therapy/etiology
MH  - Antifibrinolytic Agents/*administration & dosage
MH  - Arthroplasty, Replacement, Hip/adverse effects
MH  - Arthroplasty, Replacement, Knee/adverse effects
MH  - Blood Loss, Surgical/*prevention & control
MH  - Erythropoietin/*therapeutic use
MH  - Female
MH  - Humans
MH  - Iron/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Recombinant Proteins/therapeutic use
MH  - Retrospective Studies
MH  - Trace Elements/*therapeutic use
MH  - Tranexamic Acid/*administration & dosage
EDAT- 2018/03/06 06:00
MHDA- 2018/03/10 06:00
CRDT- 2018/03/06 06:00
PHST- 2018/03/06 06:00 [entrez]
PHST- 2018/03/06 06:00 [pubmed]
PHST- 2018/03/10 06:00 [medline]
AID - 10.1097/MD.0000000000009429 [doi]
AID - 00005792-201801050-00015 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 Jan;97(1):e9429. doi: 10.1097/MD.0000000000009429.