FIBRIN SEALANTS AND TRANEXAMIC ACID IN PRIMARY TOTAL KNEE ARTHROPLASTY

Background Tranexamic acid (TXA) and fibrin sealants have gained widespread use in total knee arthroplasty. They can decrease bleeding, drainage volume, hematoma formation, and incidence of blood transfusion. However, they are costly and carry a theoretical risk of infection transmission and thrombosis. This study compares the two pharmacologic interventions to preoperative autologous blood donation as well as no intervention. Methods This prospective study evaluated a process change within our blood management program over the last five years. The program began initially with a comparison of only routine hemostasis compared to routine preoperative autologous blood donation (PABD) for all patients (Group 1), which then evolved into a targeted PABD protocol where only anaemic patients predonated (Group 2). Subsequently, patients received topical fibrin sealant for a year (Group 3), after which the topical TXA protocol was introduced and is still in place (Group 4). Results 838 patients went through the blood management protocols. 86 patients (10%) received allogeneic blood: 6 (5%) in Group 1; 18 (9%) in Group 2; 18 (14%) in Group 3; 20 (7%) in Group 4, and 24 (26%) in the control group. No significant difference was observed between the fibrin sealant group and the TXA group with regard to the need for transfusion, but both were significantly lower than controls. The TXA group registered the lowest volume of blood loss, shortest length of stay, and lowest cost. These results were more pronounced in anaemic patients. Conclusion Both TXA and fibrin sealants were effective in reducing transfusion risk compared to control as well as PABD in primary unilateral total knee arthroplasty. Given the equivalent eαects of both pharmacologic interventions in this study, together with the cost considerations and theoretical harms from the use of blood-derived products, it would seem prudent to use tranexamic acid in preference to fibrin sealants.