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J Knee Surg 2013; 26(06): 379-386
DOI: 10.1055/s-0033-1353992
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Intraoperative Pharmacotherapeutic Blood Management Strategies in Total Knee Arthroplasty

Samik Banerjee
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Kimona Issa
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Robert Pivec
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
2   Department of Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
,
Mark J. McElroy
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Harpal S. Khanuja
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
,
Steven F. Harwin
3   Department of Orthopedic Surgery, Beth Israel Medical Center, New York, New York
,
Michael A. Mont
1   Department of Orthopedics, Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Baltimore, Maryland
› Author Affiliations
Further Information

Publication History

08 June 2013

01 July 2013

Publication Date:
16 August 2013 (online)

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Abstract

Bone and soft tissue bleeding often results in substantial amounts of blood loss following total knee arthroplasty. Multiple studies have reported that cumulative blood loss varies between 500 and 1,500 mL in primary settings. Increased perioperative blood loss frequently requires allogeneic blood transfusions to improve the hematocrit and the hemoglobin levels. However, allogeneic transfusion is associated with risks of immunosuppression, transfusion reactions, graft versus host disease, and transmission of infections. To avoid these problems and reduce costs of transfusion, multiple intraoperative pharmacotherapeutic strategies have been developed. The various pharmacotherapeutic agents currently used are tranexamic acid, epsilon-aminocaproic acid, fibrin, thrombin, lavage with epinephrine, and norepinephrine. However, the relative efficacy and the cost-effectiveness of these techniques may vary. Thus, the purpose of this study was to provide a brief overview of the relative efficacy of various intraoperative pharmacological methods currently in use for decreasing blood loss following total knee arthroplasty and describe their potential complications associated with their use.

Keywords

blood - loss - prevention - pharmacotherapy - knee - arthroplasty
 

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