Tranexamic Acid and Thromboelastography in a Revision of Total Hip Replacement and Spine Surgery
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Introduction: Thromboelastography (TEG) and antifibrinolytic drugs are useful in the diagnosis and management of patients undergoing major orthopedic surgery to reduce perioperative bleeding and transfusion requirement. We described the effect of tranexamic acid on thromboelastography parameters.
Methods: In 20 patients undergoing major orthopedic surgery, a dose of 20 mg/kg tranexamic acid followed infusion 1 mg/kg/h until the end of the procedure was administered. Two TEG were performed; baseline and a control at the end of the procedure. Thromboelastography effects are described.
Results and Conclusions: No fibrinolysis was observed in the samples taken, however in 75% of patients increased the alpha angle suggesting a higher speed in clot formation; which might suggest a different mechanism of action of Tranexamic Acid as pro coagulant. Factors such as gender and age may modify the baseline TEG. The surgical time and the type of surgery are critical in bleeding and blood product requirement.
ácido tranexámico, tromboelastografía, revisión, remplazo de cadera, Tranexamic acid, thromboelastography, hip replacements,
2. Dahl OE, Pedersen T, Kierulf P, Wesvik AB, Lund P, Arnesen H, et al. Sequential intrapulmonary and systemic activation of coagulation and fibrinolysis during and after total hip replacement surgery. Thromb Res. 1993;70:451-8.
3. Klein HG, Spahn DR, Carson JL. Red blood cell transfusion in clinical practice. Lancet. 2007;370:415-26.
4. Zufferey P, Merquiol F, Laporte S, Decousus H, Mismetti P, Auboyer C, et al. Do antifibrinolytics reduce allogeneic blood transfusion in orthopedic surgery? Anesthesiology. 2006;105(5):1034-40.
5. Ekback G, Axelsson K, Ryttberg L, Edlund B, Kjellberg J, Weckström J, et al. Tranexamic acid reduces blood loss in total hip replacement surgery. Anesth Analg. 2000; 91(5):1124-30.
6. Gill JB, Rosenstein A. The use of antifibrinolytic agents in total hip arthroplasty. J Arthroplasty. 2006;21:869-73.
7. Rivera D, Pérez A. Técnicas de ahorro sanguineo en cirugía. Rev Col Anest. 2012;39(4):545-59.
8. Roberts I, Shakur H, Ker K, Coats T; CRASH-2 Trial collaborators. Antifibrinolytic drugs for acute traumatic injury. Cochrane Database Syst Rev. 2011 Jan 19;(1):CD004896. doi:10.1002/14651858.CD004896.pub3.
9. Raffán SF, Ramírez FJ, Cuervo JA, et al. Tromboelastografía. Rev Col Anest. 2005;33:181-86.
10. Shore-Lesserson L, Heather EM, Marietta D. Thromboelastography guided therapy algorithm reduces transfusion in complex cardiac surgery. Anesth Analg. 1999;88:312-9.
11. Brenni M, Worn M, et al. Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathy. Acta Anaesthesiol Scand. 2010;54:111-7.
12. Roeloffzen W, Kluin-Nelemans HC, Mulder AB, Veeger NJ, Bosman L, de Wolf JT. In normal controls, both age and gender affect coagulability as measured by thrombelastography. Anesth Analg. 2010;110(4):987-94.
13. Kwok FG. Changes in Thrombelastograph variables associate with age. Anesth Analg. 1999;2:449-54.
14. Kish RF, Naddafnia H, Ghorbanloo M, et al. Thromboelastography analysis after autologous transfusion in patients undergoing coronary artery bypass surgery. Iranian Heart Journal [internet]. 2009;10(4):19-27. Disponible en: http://www.sid.ir/en/VEWSSID/J_pdf/86820090403.pdf.
15. Roeloffzen WW, Kluin-Nelemans HC, Bosman L, de Wolf JT. Effect of red blood cells on hemostasis. Transfusion. 2010;50(7):1536-44.