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Reducing transfusion in hip arthroplasty: tranexemic acid diminishes influence of anesthesia administered.
Combs, Dylan B; Hummel, Amelia; Nishioka, Scott T; Andrews, Samantha N; Nakasone, Cass K.
Afiliación
  • Combs DB; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
  • Hummel A; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
  • Nishioka ST; John A Burns School of Medicine, 651 Ilalo Street, Honolulu, HI, 96813, USA.
  • Andrews SN; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA.
  • Nakasone CK; Straub Medical Center, Bone and Joint Center, 888 South King Street, Honolulu, HI, 96818, USA. sandrews@hawaii.edu.
Arch Orthop Trauma Surg ; 143(6): 3535-3540, 2023 Jun.
Article en En | MEDLINE | ID: mdl-35996031
BACKGROUND: The risk of transfusion following total hip arthroplasty (THA) continues to be problematic. The best choice of anesthesia (spinal vs general) and impact of tranexamic acid (TXA) use in reducing transfusions following surgery remain unclear. Therefore, the purpose of this study was to compare rates of blood transfusion following THA via the anterior approach using three different anesthesia protocols with and without TXA. MATERIALS AND METHODS: This retrospective review included 1399 patients (1659 hips), receiving spinal anesthesia (SA) without (248 patients) and with TXA (77 patients), general anesthesia (GA) without (151 patients) and with TXA (171) and general anesthesia with paravertebral block (GA-PVB) and TXA (748 patients). All procedures were performed by a single surgeon. Chi-Squared tests and logistic regression were performed to evaluate the rate and risks of transfusion between groups. RESULTS: Without TXA, transfusion rate with GA (24.5%) was higher than SA (13.4%) (p = 0.004). With TXA, there was no difference in transfusion rates between GA (4.6%), SA (3.9%) or GA-PVB (4.0%). The multivariable regression revealed bilateral (Odds Ratio (OR): 6.473; p < 0.001), female (OR: 2.046; p = 0.004), age (OR: 1.028; p = 0.012) and pre-operative anemia (OR: 2.604; p < 0.001) as increasing the risk of transfusion while use of TXA (OR: 0.168; p < 0.001) significantly reduced transfusion risk. CONCLUSION: The use of TXA during THA via the anterior approach removed the influence of anesthesia type regarding risk of transfusion. The use of TXA may reverse presumed disadvantages of GA alone, potentially facilitating rapid discharge following surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Artroplastia de Reemplazo de Cadera / Antifibrinolíticos Límite: Female / Humans Idioma: En Revista: Arch Orthop Trauma Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ácido Tranexámico / Artroplastia de Reemplazo de Cadera / Antifibrinolíticos Límite: Female / Humans Idioma: En Revista: Arch Orthop Trauma Surg Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Alemania