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- Benefits of tranexamic acid in total knee arthroplasty: a classification and regression tree analysis in function of instrumentation, BMI, and genderPublication . Pereira, Eduardo; Carvalho, Maria Miguel; Oliveira, Tiago; Sacramento, Telmo; Cruz, Henrique; Viegas, Rui; Fontes, Ana Paula; Marreiros, Ana; Sousa, João PauloTranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient’s body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn’t used, the lowest blood loss was obtained in patients submitted to TKA with PS
- Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplastyPublication . Viegas, Rui; Kumar, Abhishek; Carvalho, Maria M.; Vide, João; Fontes, Ana Paula; Sousa, João P.Background: Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA. Methods: We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared. Results: Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml). Conclusions: TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.