Abstract
Perioperative blood management is essential to minimize allogeneic blood transfusion
in total knee replacement. The effect of preoperative administration of erythropoietin,
intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies
on allogeneic transfusion is studied in total knee replacement. A retrospective comparative
study of 106 patients who underwent total knee replacement in different time periods
was performed. Group A (n
1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group
B (n
2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was
given preoperatively. Patients of Group C (n
3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly,
in Group D (n
4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative
and discharge hemoglobin together with total units of blood transfusion and creatinine
levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82
units/patient, p < 0.001, CI 95%) in contrast to the two regimens of erythropoietin (1.16 units/patient)
OrthoPAT (1.43 units/patient) and restrictive strategies (1.92 units/patient). The
mean preoperative hemoglobin was 13.37 g/dL with no statistical difference among the
groups of patients. The postoperative mean hemoglobin was 10.59 with no statistical
difference among the groups of patients too. Additionally, the mean creatinine level
was 0.93 mg/dL; however, no statistical difference among the groups of patients was
noted. Finally, tranexamic acid seemed to be the most cost-effective regime. In our
study, tranexamic acid proved its superiority concerning the postoperative blood transfusion
on patients undergoing total knee replacement, in comparison with the other existing
methods of perioperative blood management. This is a Level III, retrospective comparative
study.
Keywords
blood management - total knee replacement - tranexamic acid
