Yıl 2020, Cilt 10 , Sayı 1, Sayfalar 86 - 90 2020-03-31

Turnikesiz Unilateral Total Diz Artoplastisi Sonrası Kanama Kontrolünde Topikal Uygulanan Traneksamik Asitin Etkinliği
The Efficacy of Topical Tranexamic Acid in Bleeding Control After Unilateral Total Knee Arthoplasty without Tourniquet

Recep KURNAZ [1]


Amaç: Total diz artroplastisi(TDA) sonrası kan kaybını, hemoglobin düşüklüğünü, kan transfüzyon ihtiyacını ve hastanede kalış süresini azaltmak için traneksamik asit (TXA)’ in topikal uygulamasındaki etkinliğini değerlendirmektir.
Yöntem: Total diz artroplastisi yapılan 40 hasta, 59-83 yaşları arasından seçilmiştir. VAS 7’ nin üzerinde, Ahlback evre 4-5 ve ASA 1. ve 2. grup olan hastalar çalışmaya dahil edilmiştir. Ameliyatlar aynı cerrah ve standart medial parapatellar artrotomi ile aynı marka implantlar kullanılarak yapılmıştır. Ameliyat boyunca turnike sadece sementleme aşamasında kullanılmıştır. Koagülopati, pulmoner emboli, akut myokard enferktüsü, beyin felci, kronik arter hastalığı hikayesi olanlar ve hemoglobin seviyesi 10 g/dl nin altında olan hastalar çalışmaya alınmamıştır. Hastalar 2 gruba ayrıldı. Grup A’ daki hastalara artrotomi kapatıldıktan sonra 4 ampül 250 mg %10 TXA salin ile seyreltilerek diz eklemine enjekte edildi. 2 saat boyunca dren kapalı tutuldu. Grup B’ deki hastalarda TXA kullanılmadı. Drenler 48. Saat sonunda çekildi. Kan hemoglobin değerleri 8 g/dl’ nin altına düşmedikçe kan transfüzyonu yapılmadı. Hastalar ko-morbiditeleri açısından da değerlendirmeye alındı.
Bulgular: 40 hastanın 8 (%20)’ ine kan transfüzyonu yapıldı. Bunların 6 (%75)’ sı TXA kullanılmayan Grup B’ deki hastalar idi. Grup A’ da sadece hastaların 2 (%10)’ sine kan trasfüzyonu yapıldı. Grup B’ deki kan trasfüzyonu yapılan hastaların 1 tanesine 2 ünite kan replase edilmiştir. Ameliyat sonrası ilk 24 saatteki kan drenaj miktarlarına bakıldığında Grup A’ da 232,5 cc, Grup B’ de 407,75 cc idi. 48. saat sonundaki toplam drenaj miktarına bakıldığında Grup A’ da 370,5 cc, Grup B’ de 552,2 cc olarak görüldü.
Ameliyat sırasında ortalama kanama miktarı Grup A’ da 247,5 cc, Grup B’ de 235 cc idi. Ameliyat öncesi ortalama hemoglobin değeri Grup A’ da 13 g/dl iken Grup B’ de 12,75 g/dl idi. Ameliyattan sonraki 6. Saatte alınan hemoglobin değeri Grup A’ da 11,7, Grup B’ de 11 g/dl olarak gözlendi. Ameliyat sonrası ilk 24. saatteki hemoglobin değerleri Grup A’ da 11,07 iken Grup B’ de 10,6 idi. 48. saatteki hemoglobin değerleri Grup A’ da 10,3 iken Grup B’ de 9,5 olarak gözlendi. Postop dönemdeki hemoglobin değişim seviyelerine ve drenaj miktarlarına bakıldığında TXA kullanılan grupta özellikle ilk 24. saatteki drenaj miktarında diğer gruba oranla önemli bir azalma olduğu gözlemlenmiştir.
Çıkarımlar: Total diz artroplastisinde traneksamik asit kullanımı postoperatif kanama miktarını anlamlı şekilde azaltır. TXA' nın intravenöz yerine eklem içi olarak uygulanmasıyla sistemik absorpsiyon azaltılabilir ve istenmeyen yan etkiler hafifletilebilir. Bu çalışmanın bulguları toplam kan kaybında ve hemoglobin seviyelerindeki azalmada bir düşüş olduğunu ve dolayısıyla kan transfüzyonu ihtiyacını azalttığını göstermiştir.

Aim: The aim of this study is to evaluate the efficacy of tranexamic acid (TXA) in the topical application of total knee arthroplasty (TKA) to reduce blood loss, low hemoglobin, need for blood transfusion and hospital stay.
Materials and Method: Forty patients undergoing total knee arthroplasty were selected from 59-83 years of age. Patients with VAS 7 above Ahlback stage 4-5 and ASA group 1 and 2 were included in the study. The operations were performed using the same surgeon and standard medial parapatellar arthrotomy using the same brand implants. During the operation, the tourniquet was used only during cementation. Patients with a history of coagulopathy, pulmonary embolism, acute myocardial infarction, cerebral palsy, chronic arterial disease and patients with hemoglobin levels below 10 g / dl were excluded from the study. The patients were divided into two groups. In Group A, 4 ampoules of 250 mg 10% TXA saline were injected into the knee joint after arthrotomy was closed. The drain was kept closed for 2 hours. TXA was not used in Group B patients. Drains drained at 48 hours. Blood transfusion was not performed unless the blood hemoglobin values fell below 8 g / dl. The patients were also evaluated for their co-morbidities.
Results: Blood transfusion was performed in 8 (20%) of 40 patients. Six (75%) of these patients were in Group B without TXA. In Group A, only 2 (10%) patients underwent blood transfusion. In Group B, 2 units of blood were replaced in 1 patient. Blood drainage levels in the first 24 hours were 232.5 cc in Group A and 407.75 cc in Group B. When the total drainage amount at the end of 48th hour was examined, it was seen as 370.5 cc in Group A and 552.2 cc in Group B. The mean amount of bleeding during surgery was 247.5 cc in Group A and 235 cc in Group B. The mean preoperative hemoglobin level was 13 g / dl in Group A and 12.75 g / dl in Group B. Hemoglobin levels taken at the 6th postoperative hour were 11.7 in Group A and 11 g / dl in Group B. Hemoglobin levels in the first 24 hours postoperatively were 11.07 in Group A and 10.6 in Group B. Hemoglobin values at the 48th hour were 10.3 in Group A and 9.5 in Group B. When the postoperative hemoglobin change levels and the amount of drainage were examined, it was observed that there was a significant decrease in the amount of drainage in the first 24 hours compared to the other group.
Conclusion:The use of tranexamic acid in total knee arthroplasty significantly reduces the amount of postoperative bleeding. Systemic absorption can be reduced and undesirable side effects can be alleviated by intra-articular administration of TXA instead of intravenous. The results of this study showed that there was a decrease in total blood loss and decrease in hemoglobin levels and thus reduced the need for blood transfusion.
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Orcid: 0000-0002-8311-047X
Yazar: Recep KURNAZ (Sorumlu Yazar)
Kurum: Eskişehir Acıbadem Hastanesi, Ortopedi ve Travmatoloji Kliniği
Ülke: Turkey


Tarihler

Kabul Tarihi : 8 Mart 2020
Yayımlanma Tarihi : 31 Mart 2020

AMA KURNAZ R . Turnikesiz Unilateral Total Diz Artoplastisi Sonrası Kanama Kontrolünde Topikal Uygulanan Traneksamik Asitin Etkinliği. J Contemp Med. 2020; 10(1): 86-90.