Uso tópico de ácido tranexámico en el reemplazo total de rodilla primario. [Topical administration of tranexamic acid in primary total knee replacement.]

Agustin Dauria, Hector Mario Depetris

Resumen


Introducción

El reemplazo total de rodilla es un procedimiento que  puede  generar una gran pérdida sanguínea durante el posoperatorio. El ácido tranexámico es un agente sintético antifbrinolítico, que en los últimos años, se ha estado utilizando en forma endovenosa con buenos resultados al reducir el sangrado asociado al reemplazo total de rodilla. Sin embargo,  existe escasa experiencia con el uso tópico del mismo.

Materiales y Métodos

Hemos llevado a cabo un estudio comparativo retrospectivo, analizando 117 reemplazos totales de rodilla primarios, donde comparamos los resultados obtenidos de 63 cirugías con el uso tópico de ácido tranexámico, con los 54 reemplazos restantes donde no se utilizó tranexámico. Se comparó la tasa de transfusión, niveles de hemoglobina y hematocrito a las 24 y 48 hs, curaciones requeridas, comorbilidades asociadas y complicaciones presentes.

Resultados

El  grupo de uso tópico de ácido tranexámico mostró una reducción de la tasa de transfusiones en un 43.9%, comparándolo con el grupo donde no se utilizó el mismo. Además, se registró una reducción en la caída de la hemoglobina a las 24hs posoperatorias de 2,12 gr/dl. No se registraron complicaciones.

Conclusiones

El uso tópico de ácido tranexámico en reemplazos totales primarios de rodilla disminuye los requerimientos de transfusiones, sin incrementar el riesgo de complicaciones.

 

 

Abstract


Introduction: Total knee replacement is associated with extensive postoperative blood loss. Tranexamic acid is a synthetic antifibrinolytic agent that, in the last few years, has been successfully used intravenously to reduce bleeding after total knee replacement. However, topical application of tranexamic acid in total knee replacement remains largely unexplored.


Methods: A retrospective study of 117 primary total knee replacements was conducted: 63 surgeries with topical tranexamic acid and 54 replacements without tranexamic acid. A comparison analysis was made, capturing results of blood transfusion rates, postoperative hemoglobin levels (24 and 48 hours), number of changed bandages, comorbidities and
complications.


Results: Tranexamic acid reduced blood transfusion rate by 43.9% when compared with the group without tranexamic acid. A lower decline in postoperative hemoglobin levels (24 hours) by 0.2-1.3 g/dL was also observed in this same group. There were no complications in both groups.


Conclusions: Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement, without additional adverse effects.

 

 


Palabras clave


ácido tranexamico; reemplazo total de rodilla; transfusiones sanguíneas.Tranexamic acid; total knee replacement; blood transfusion.

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Referencias


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DOI: http://dx.doi.org/10.15417/697

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Registro de la Propiedad Intelectual Nº 5353562 (en línea).

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