Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid
Language English Country Czech Republic Media print-electronic
Document type Journal Article, Randomized Controlled Trial
PubMed
31551606
DOI
10.5507/bp.2019.034
Knihovny.cz E-resources
- Keywords
- D-dimers, FDP, blood loss, combined administration, intravenous administration, plasminogen, topical application, total knee arthroplasty, tranexamic acid,
- MeSH
- Antifibrinolytic Agents administration & dosage MeSH
- Administration, Topical MeSH
- Osteoarthritis, Knee surgery MeSH
- Fibrin Fibrinogen Degradation Products metabolism MeSH
- Hematocrit MeSH
- Hemoglobins metabolism MeSH
- Administration, Intravenous MeSH
- Blood Loss, Surgical * MeSH
- Tranexamic Acid administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Plasminogen metabolism MeSH
- Postoperative Hemorrhage epidemiology MeSH
- Aged MeSH
- Arthroplasty, Replacement, Knee methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Names of Substances
- Antifibrinolytic Agents MeSH
- fibrin fragment D MeSH Browser
- Fibrin Fibrinogen Degradation Products MeSH
- Hemoglobins MeSH
- Tranexamic Acid MeSH
- Plasminogen MeSH
AIM: We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. METHODS: In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). RESULTS: Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). CONCLUSION: The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.
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