Yoeri Bemelmans

Chapter 3 38 Table 2. Adverse event and readmission rates for the total cohort presented as frequencies (%). Total Embolism (VTE/LE) 15 (0.29) Neurologic (e.g. CVA, TIA) 7 (0.13) Infection (e.g. surgical site infection) 23 (0.44) Wound related (e.g. persistent drainage, dehiscence, haematoma) 79 (1.5) Prosthesis related (e.g. dislocation, periprosthetic fracture) 74 (1.4) Cardiac (e.g. acute myocardial infarction, acute heart failure, rhythm disorder) 16 (0.3) Urologic (e.g. postoperative urinary tract infection, urinary retention) 191 (3.6) Other (e.g. organ infection/dysfunction, nerve lesion) 77 (1.5) Readmissions <3mnd post OR 262 (5.0) VTE, venous thrombo embolism; LE, lung embolism; CVA, cerebrovascular accident; TIA, transient ischemic attack Discussion Themost important finding of thepresent study is that theuse of TXA inprimaryhip- and knee arthroplasty results in lowallogenic blood transfusion rates. Before implementation of TXA in hip- and knee arthroplasty, allogenic blood transfusion rates rose tomore than half of the patients [9]. These transfusion rates decreased significantly by implementing a perioperative TXA protocol without increasing perioperative complications (e.g. thromboembolic, cardiovascular events) [10,19,11]. Different protocols are examined and proven to be effective and safe [3,8,10,11,19,21,29]. Nevertheless, none of these regimens regarding type of administration (e.g. topical, IV and oral), dosage and timing is superior [10]. Inprevious high-quality studies (e.g. meta-analysis) different types of administration resulted in similar decreased transfusion risks for TKA and THA patients [11,27,30]. Only in TKA patients, slight superiority is found for pre-incisional administration of IV TXA [11]. In terms of safety, multiple doses induce a prothrombotic state but do not provoke thrombosis in TKA and THA patients and would therefore be safe to use [28]. But, as known from the recent literature, a second or extended dose seems not to be more effective than single dosage in knee or hip arthroplasty [11]. No differences were found between low (<20mg/kg) and high (>20mg/kg) dose intravenous TXA in hip and knee arthroplasty [11]. As well as for timing of administration, no regimen is superior [2,11]. The protocol in this study was set-up to be firstly evidence based, but secondly manageable without any nuisance for the patient. Due to the current fast-track protocols, which include 2hrs preoperative oral administration of pain medication, the implementation of preoperative oral TXA was done at that same administration time.