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
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 N...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Palacký University Olomouc, Faculty of Medicine and Dentistry
2020-06-01
|
| Series: | Biomedical Papers |
| Subjects: | |
| Online Access: | https://biomed.papers.upol.cz/artkey/bio-202002-0008_monitoring-of-fibrinolytic-system-activity-with-plasminogen-d-dimers-and-fdp-in-primary-total-knee-arthroplast.php |
| _version_ | 1830353603459547136 |
|---|---|
| author | Jiri Lostak Jiri Gallo Ludek Slavik Jana Zapletalova Lubos Balaz |
| author_facet | Jiri Lostak Jiri Gallo Ludek Slavik Jana Zapletalova Lubos Balaz |
| author_sort | Jiri Lostak |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T01:16:43Z |
| format | Article |
| id | doaj.art-2bd1d2423fb446e6b048cea9cc732ec0 |
| institution | Directory Open Access Journal |
| issn | 1213-8118 1804-7521 |
| language | English |
| last_indexed | 2024-12-20T01:16:43Z |
| publishDate | 2020-06-01 |
| publisher | Palacký University Olomouc, Faculty of Medicine and Dentistry |
| record_format | Article |
| series | Biomedical Papers |
| spelling | doaj.art-2bd1d2423fb446e6b048cea9cc732ec02022-12-21T19:58:33ZengPalacký University Olomouc, Faculty of Medicine and DentistryBiomedical Papers1213-81181804-75212020-06-01164216817610.5507/bp.2019.034bio-202002-0008Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acidJiri Lostak0Jiri Gallo1Ludek Slavik2Jana Zapletalova3Lubos Balaz4Department of Orthopaedics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech RepublicDepartment of Orthopaedics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech RepublicDepartment of Haemato-Oncology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech RepublicDepartment of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech RepublicDepartment of Orthopaedics, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech RepublicAim: 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.https://biomed.papers.upol.cz/artkey/bio-202002-0008_monitoring-of-fibrinolytic-system-activity-with-plasminogen-d-dimers-and-fdp-in-primary-total-knee-arthroplast.phptranexamic acidtotal knee arthroplastytopical applicationintravenous administrationcombined administrationplasminogend-dimersfdpblood loss |
| spellingShingle | Jiri Lostak Jiri Gallo Ludek Slavik Jana Zapletalova Lubos Balaz 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 Biomedical Papers tranexamic acid total knee arthroplasty topical application intravenous administration combined administration plasminogen d-dimers fdp blood loss |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | tranexamic acid total knee arthroplasty topical application intravenous administration combined administration plasminogen d-dimers fdp blood loss |
| url | https://biomed.papers.upol.cz/artkey/bio-202002-0008_monitoring-of-fibrinolytic-system-activity-with-plasminogen-d-dimers-and-fdp-in-primary-total-knee-arthroplast.php |
| work_keys_str_mv | AT jirilostak monitoringoffibrinolyticsystemactivitywithplasminogenddimersandfdpinprimarytotalkneearthroplastytkaaftertopicalintravenousorcombinedadministrationoftranexamicacid AT jirigallo monitoringoffibrinolyticsystemactivitywithplasminogenddimersandfdpinprimarytotalkneearthroplastytkaaftertopicalintravenousorcombinedadministrationoftranexamicacid AT ludekslavik monitoringoffibrinolyticsystemactivitywithplasminogenddimersandfdpinprimarytotalkneearthroplastytkaaftertopicalintravenousorcombinedadministrationoftranexamicacid AT janazapletalova monitoringoffibrinolyticsystemactivitywithplasminogenddimersandfdpinprimarytotalkneearthroplastytkaaftertopicalintravenousorcombinedadministrationoftranexamicacid AT lubosbalaz monitoringoffibrinolyticsystemactivitywithplasminogenddimersandfdpinprimarytotalkneearthroplastytkaaftertopicalintravenousorcombinedadministrationoftranexamicacid |