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Benefits of tranexamic acid in total knee arthroplasty: a classification and regression tree analysis in function of instrumentation, BMI, and gender

2021-07-05Journal article Open access
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dc.contributor.authorPereira, Eduardo
dc.contributor.authorCarvalho, Maria Miguel
dc.contributor.authorOliveira, Tiago
dc.contributor.authorSacramento, Telmo
dc.contributor.authorCruz, Henrique
dc.contributor.authorViegas, Rui
dc.contributor.authorFontes, Ana Paula
dc.contributor.authorMarreiros, Ana
dc.contributor.authorSousa, João Paulo
dc.date.accessioned2023-01-17T11:56:28Z
dc.date.available2023-01-17T11:56:28Z
dc.date.issued2021-07-05
dc.date.updated2023-01-14T20:31:25Z
dc.description.abstractTranexamic 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 PSpt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.doi10.1055/s-0041-1731455pt_PT
dc.identifier.issn1538-8506
dc.identifier.issn1938-2480
dc.identifier.slugcv-prod-2556315
dc.identifier.urihttp://hdl.handle.net/10400.1/18835
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherThieme Gruppept_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectTotal knee replacementpt_PT
dc.subjectTranexamic acidpt_PT
dc.subjectInstrumentationpt_PT
dc.subjectSurgical blood losspt_PT
dc.subjectPlasminogen activator inhibitorspt_PT
dc.titleBenefits of tranexamic acid in total knee arthroplasty: a classification and regression tree analysis in function of instrumentation, BMI, and genderpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceEstados Unidospt_PT
oaire.citation.titleThe Journal of Knee Surgerypt_PT
person.familyNamePereira
person.familyNameMarreiros
person.givenNameEduardo
person.givenNameAna
person.identifier.ciencia-id9A12-9450-7051
person.identifier.orcid0000-0002-9005-5720
person.identifier.orcid0000-0001-9410-4772
person.identifier.scopus-author-id57194785077
rcaap.cv.cienciaid6E12-B4BA-87AF | Ana Paula de Almeida Fontes
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication8c2aa4c7-4ff5-454c-b655-5d389b9ddab1
relation.isAuthorOfPublicationc0a8e5da-26ae-42a8-ab04-fa4df4356375
relation.isAuthorOfPublication.latestForDiscoveryc0a8e5da-26ae-42a8-ab04-fa4df4356375

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