Total Diz Artroplastisi Sonrası Sistemik ve İntraartiküler Traneksamik Asit Uygulaması ile Kan Kaybının Azalması

Amaç: Total diz artroplastisi (TDA) sırasında perioperatif kanama cerrahlar için devam eden bir problemdir. Traneksamik asidin (TXA) intravenöz veya intra-artiküler uygulanması kanamayı etkili bir şekilde durdurabilir, ancak en iyi uygulama ve doz yöntemi için hala bir standart yoktur. Gereç ve Yöntem: Ekim 2017 ile Eylül 2019 arasında diz replasmanı gerektiren tek taraflı primer diz osteoartriti olan 90 hasta retrospektif olarak değerlendirildi ve üç grup olarak incelendi. Grup 1 (n = 30) intravenöz(IV) , grup 2 (n = 30) intra-artiküler enjeksiyon (IAE) ve grup 3 (n = 30) ) TXA’nın hem IV hemde IA kombine enjeksiyon uygulanmıştır. Demografik özellikler, hematolojik indeksler, derin ven trombozu (DVT) ve pulmoner emboli( PE) görülme insidansı araştırıldı. Bulgular: Çalışmaya dahil edilen hastaların %86’sı kadın (n=78) ve %14’ü erkektir (n=12). Gruplara göre cinsiyet dağılımı homojendir (p=0,749). Grup 2’nin Hemoglobin(Hb) ortalamaları Grup 1 ve Grup 3’ün Hb ortalamalarından istatistiksel olarak anlamlı derecede düşük bulunmuş (p=0,002, p=0,045), Kombine IV ve IA TXA alan grupta postoperatif daha az kan kaybı gözlendi. Grup 3’ün Drenden Kan Kaybı ortalamaları Grup 1 ve Grup 2’nin Drenden Kan Kaybı ortalamalarından istatistiksel olarak anlamlı derecede düşük bulunmuş (p=0,001). Hiçbir grupta ameliyat sonrası enfeksiyon, DVT ve PE görülmemiştir. Sonuç: Bu çalışma primer tektaraflı TDA'da intraartiküler ve intravenöz traneksamik asidin kullanılmasının postoperatif kan kaybını anlamlı derecede azalttığını ve bunun sonucu olarak advers olaylarda, özellikle tromboembolik olaylarda bir artış olmadan kan transfüzyonu ihtiyacını azalttığını göstermiştir.

Decreased Blood Loss with Systemic and Intraarticular Tranexamic Acid Administration after Total Knee Arthroplasty

Objective: Perioperative bleeding during total knee arthroplasty (TKA) is a lastingproblem for surgeons. Intravenous or intra-articular administration of tranexamic acid(TXA) can effectively stop bleeding, but there is still no uniform standard for the bestadministration and dosing.Methods: Between October 2017 and September 2019, ninety patients with unilateralprimary knee osteoarthritis requiring knee replacement were retrospectively evaluated andinvestigated in three groups according to the route of TXA administration: Group 1(n=30) intravenous (IV) injection, Group 2 (n=30) intra-articular injection (IAI), andGroup 3 (n = 30) combined IV and IAI. Demographic characteristics, hematologicalindices, and the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE)were studied.Results: Of the patients included in the study, 86% were female (n=78), and 14% weremale (n=12). The gender distribution of the groups was homogeneous (p=0.749). Themean hemoglobin values of Group 2 were significantly lower than those of Group 1 andGroup 3 (p=0.002 and p=0.045, respectively). Less postoperative blood loss was observedin the group receiving combined IV and IA TXA. The mean blood loss from the drain inGroup 3 was significantly lower than that in Group 1 and Group 2 (p=0.001).Postoperative infection, DVT, and PE were not seen in any group.Conclusions: This study demonstrated that the use of intraarticular and intravenoustranexamic acid in primary unilateral TKA significantly reduced postoperative blood lossand consequently decreased the need for blood transfusion without an increase in adverseevents, particularly thromboembolic complications.

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ISSN: 1309-3878
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 2009
Yayıncı: Düzce Üniversitesi Tıp Fakültesi Aile Hekimliği AD adına Yrd.Doç.Dr.Cemil Işık Sönmez