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Use of tranexamic acid in patients with hemophilia A during knee arthroplasty

DOI: https://doi.org/10.29296/25877305-2020-07-15
Issue: 
7
Year: 
2020

D. Petrovsky; Professor V. Zorenko, MD; T. Polyanskaya, Candidate of Medical Sciences; E.
Karpov, M. Sampiev, N. Sadykova, Candidate of Medical Sciences; G. Mishin, A. Golobokov, A. Koroleva
National Medical Research Center of Hematology, Ministry of Health of Russia, Moscow

Objective: to reduce intraoperative and early postoperative blood loss in patients with hemophilia A during endoprosthetics of the large joints. Subjects and methods. The investigation enrolled 29 patients aged 28 to 56 years with severe hemophilia A, who underwent knee arthroplasty. All the patients had end-stage hemophilic arthropathy with pronounced pain syndrome. The patients were divided into 2 groups. Hemostatic therapy only with factor VIII (FVIII) preparations was performed in Group 1 in the intraoperative and postoperative periods; FVIII in combination with tranexamic acid (TXA) was used in Group 2 intraoperatively and in the first 3 days. Hemostasis with FVIII was carried out according to the standard scheme, by calculating that the intraoperative level of the factor in the patient’s blood was at least 100%. TXA was given at a dose of 10–15 mg/kg at an interval of every 8 hours. Results and discussion. All surgical treatments yielded satisfactory or good results at follow-ups of at least 1-3 years. In the FVIII+TXA group, the intraoperative blood loss was an average of 350 ml (23 to 34%) less than that in the FVIII group. In the postoperative period, Group 1 also showed an average 25% reduction in blood loss into the drains. During early postoperative hospital stay (from 14 to 28 days after surgery), postoperative wound healing and rehabilitation were better in the FVIII+TXA group than those in the FVIII group. The patients had less marked soft tissue hematomas and swelling at the operated joint site, which allowed earlier and more effective movement developments to be initiated. No cases of thrombotic events were noted.

Keywords: 
hematology
surgery
hemophilia A
hemophilic arthropathy
knee arthroplasty
tranexamic acid
intraoperative blood loss



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