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Regional Hemostatic Status and Blood Requirements After Total Knee Arthroplasty With and Without Tranexamic Acid or Aprotinin

2001; Lippincott Williams & Wilkins; Volume: 92; Issue: 3 Linguagem: Inglês

10.1213/00000539-200103000-00041

1526-7598

Jörg M. Engel, Tove Hohaus, Ralph Ruwoldt, T. Menges, Imke Jürgensen, G. Hempelmann,

Venous Thromboembolism Diagnosis and Management

Antifibrinolytics seem to reduce postoperative blood loss after total knee arthroplasty. Few studies have shown the impact of these drugs on the mechanisms of coagulation. The purpose of this study was to examine coagulation/fibrinolysis variables as well as blood loss after total knee arthroplasty with and without antifibrinolytics in the operated limb on a regional level. Thirty-six patients were randomized into one of three groups to receive aprotinin, tranexamic acid, or no medication. We took blood samples of the femoral vein before deflating the tourniquet and after 5, 10, 30, 60, 120 min and on the first postoperative day. The implantation of a knee prosthesis in artificial ischemia caused a significant activation of coagulation and fibrinolysis in the regional circulation. Tranexamic acid and aprotinin did not cause a significant modulation of fibrinolysis variables or a significant reduction of postoperative bleeding and transfusion requirements. One of the differences in comparison to other studies was the decreased total blood loss. The use of bone cement as well as surgical hemostasis before wound closure may be regarded as reasons for this. Therefore, primarily these methods should be used because there is no increased risk of adverse drug effects.