Tek seferlik yüksek doz topikal traneksamik asit uygulamasının total diz artroplastisi sonrası kanama ve komplikasyonlar üzerine etkisi: Retrospektif klinik çalışma

Year 2020, , 294 - 299, 30.09.2020

Ekin Kaya Şimsek Bahtiyar Haberal

https://doi.org/10.18663/tjcl.791064

Abstract

Amaç: Literatürde ortopedik cerrahide Traneksamik asit (TA) kullanımının optimal yöntemi konusunda fikir birliği yoktur. Bu çalışmanın amacı, total diz artroplastisi (TDA) cerrahisinde tek yüksek doz (3g) topikal TA uygulamasının postoperatif kanama ve komplikasyonlar üzerine etkilerini değerlendirmektir.
Gereç ve Yöntemler: Ocak 2016 - Haziran 2018 tarihleri arasında kliniğimizde TDA uygulanan hastalar retrospektif olarak değerlendirildi. Hastalar TA uygulamasına göre iki gruba ayrıldı: Grup 1 (topikal TA, n = 105/242) ve Grup 2 (TA olmayan, n = 137/242). Demografik parametreler, komorbiditeler, yüksek risk faktörleri, preoperatif hemoglobin (Hb) düzeyi, postoperatif en düşük Hb düzeyi, Hb'deki toplam değişiklik, toplam dren çıkışı, transfüzyon varlığı veya yokluğu, transfüzyon yapılan kan miktarı, hastanede kalış süresi ve komplikasyonlar değerlendirildi.
Bulgular: Grup 1'de postoperatif birinci ve ikinci gün Hb seviyeleri grup 2'ye göre anlamlı olarak yüksekti. Grup 1'de ameliyat günü kan kaybı, ameliyat sonrası ilk gün kan kaybı ve toplam dren kan kaybı anlamlı olarak daha düşüktü. Grup 2'deki hastaların anlamlı olarak daha fazla kan transfüzyonuna ihtiyaç duydukları ve hastanede kalış sürelerinin daha uzun olduğu belirlendi. İki grup arasındaki komplikasyonlarda istatistiksel olarak anlamlı fark saptanmadı.
Sonuç: Bu çalışmada, TA'nın yara kapatıldıktan sonra diz eklemine topikal uygulaması; primer TDA yapılan hastalarda tromboembolik riskte bir artış yaratmadan, postoperatif Hb kaybını ve kan kaybını önemli ölçüde azaltmıştır. Bu durum hastanede kalış süresini de azaltmaktadır.

Keywords

Total diz artroplastisi, traneksamik asit, ; kan kaybı, transfüzyon, komplikasyon

Effects of single high dose topical tranexamic acid administration on bleeding and complicatıons after total knee arthroplasty surgery:A retrospective clinical study

Abstract

Aim: There is no consensus on the optimal method of Tranexamic acid (TA) usage in orthopaedic surgery in the literature. The aim of this study is to evaluate the effects of single high dose (3g) topical TA application on postoperative bleeding and complications in total knee arthroplasty (TKA) surgery.
Material and Methods: We retrospectively evaluated patients who underwent TKA in our clinic between January 2016 and June 2018. The patients were divided into two groups according to TA administration: Group 1 (topical TA, n=105/242) and Group 2 (non-TA, n=137/242). Demographic parameters, comorbidities, high-risk factors, preoperative hemoglobin (Hb) level, lowest postoperative Hb level, change in Hb, total drainage output, presence or absence of a transfusion, amount of blood transfused, length of stay, and complications were evaluated.

Results:In group 1, postoperative first- and second-day Hb levels were significantly higher than those in group 2. The blood loss on the day of surgery, the blood loss on the first postoperative day and total drain blood loss were significantly lower in group 1. It was determined that the patients in group 2 needed significantly more blood transfusions and had more length of hospital stay. There was no statistical difference in complications between the two groups.
Conclusion:Topical TA application effectively and significantly reduces blood loss and transfusion rates after surgery, without serious side effects, in patients undergoing primary TKA. This also reduces the length of the hospital stay.

Keywords

Total knee arthroplasty, tranexamic acid, blood loss, transfusion, complication

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