scholarly journals Blood transfusions increase the risk for venous thromboembolism events following total joint arthroplasty

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Noam Shohat ◽  
Leanne Ludwick ◽  
Graham S. Goh ◽  
Matthew Sherman ◽  
Joseph Paladino ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Strong Association ◽  
Perioperative Period ◽  
Joint Arthroplasty ◽  
Phone Call ◽  
Blood Transfusions ◽  
Allogenic Blood ◽  
Clinical Notes ◽  
Thromboembolism Events ◽  
Clinical Records

AbstractThe association between blood transfusions and thromboembolic events (VTE) following total joint arthroplasty (TJA) remains debatable. Using contemporary institutional data, this study aimed to determine whether blood transfusions increase the risk of VTE following primary and revision TJA. This was a single institution, retrospective cohort study. The clinical records of all patients (n = 34,824) undergoing primary and revision TJA between 2009 and 2020 were reviewed. Demographic variables, co-morbidities, type of chemoprophylaxis and intraoperative factors such as use of tranexamic acid were collected. Clinical notes, hospital orders, and discharge summaries were reviewed to determine if a patient received a blood transfusion. Comprehensive queries utilizing keywords for VTE were conducted in clinical notes, physician dictations, and patient-provider phone-call logs. Propensity score matching as well as adjusted mixed models were performed. After adjusting for various confounders, results from regression analysis showed a significant association between allogenic blood transfusions and risk for developing VTE following primary and revision TJA (OR 4.11, 95% CI 2.53–6.69 and OR 2.15, 95% CI 1.12–4.13, respectively). While this strong association remained significant for PE in both primary (p < 0.001) and revision (p < 0.001) matched cohorts, it was no longer statistically significant for DVT (p = 0.802 and p = 0.65, respectively). These findings suggest that the risk of VTE is increased by approximately three-folds when blood transfusions are prescribed. This association was mainly due to higher symptomatic PE events which makes it even more worrisome. Surgeons should be aware of this association, revisit criteria for blood transfusions and use all means available in the perioperative period to optimize the patients and avoid transfusion.

Tranexamic acid administration during total joint arthroplasty surgery is not associated with an increased risk of perioperative seizures: a national database analysis

2020 ◽  
Vol 45 (7) ◽  
pp. 505-508
Author(s):  
Meghan A Kirksey ◽  
Lauren A Wilson ◽  
Megan Fiasconaro ◽  
Jashvant Poeran ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Total Joint Arthroplasty ◽  
Perioperative Period ◽  
Joint Arthroplasty ◽  
National Database ◽  
Institutional Review ◽  
Frequent Use ◽  
Increased Risk ◽  
History Of ◽  
Time Utilization

BackgroundTranexamic acid (TXA) has been used extensively to minimize blood loss in cardiac surgery and more recently in orthopedic surgery. Despite a generally good safety profile, an increased risk of seizures has been observed in patients with cardiac disease. However, this issue has not been adequately addressed in the orthopedic literature.MethodsAfter institutional review board approval, we queried a large national database to identify patients who had undergone total hip and total knee arthroplasties (2012–2016). Patients were divided based on their exposure to TXA and history of seizures. The main outcome of interest was a perioperative seizure. We conducted univariable comparisons and a multivariable regression analysis to elucidate a potential independent association between TXA administration and seizures in the perioperative period (with or without a history of seizures).ResultsTXA was used overall in 45.9% (n=4 21 890) of joint arthroplasty recipients (n=9 18 918), with more frequent use over time. Utilization rates did not differ between those with and without a history of seizures; 42.2% (3487/8252) of patients with a seizure history received TXA. Rates of perioperative seizure were low and did not differ between those who did and did not receive TXA (0.01% vs 0.02%, p=0.11); when subgrouping patients by history of seizures, we found no difference in incidence of perioperative seizures between groups (0.06% vs 0.02%, p=0.39). Our adjusted analysis further confirmed these results.ConclusionDespite increasing TXA utilization in total joint arthroplasty, we found an overall low seizure incidence. TXA use was not associated with elevated odds of perioperative seizure, even in patients with history of seizure.

Relationship between Nadir Hematocrit during Cardiopulmonary Bypass and Postoperative Hyperglycemia in Nondiabetic Patients

2015 ◽  
Vol 17 (6) ◽  
pp. 302 ◽  
Author(s):  
Utkan Sevuk ◽  
Nevzat Cakil ◽  
Rojhat Altindag ◽  
Erkan Baysal ◽  
Bernas Altintas ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Perioperative Period ◽  
Allogenic Blood Transfusion ◽  
Blood Transfusions ◽  
Bypass Grafting ◽  
Allogenic Blood ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
The Relationship

<p><b>Background:</b> Hyperglycemia is common after cardiac surgery in both diabetic and nondiabetic patients and is associated with increased morbidity and mortality. Association between nadir hematocrit levels on cardiopulmonary bypass (CPB) and postoperative hyperglycemia is not clear. This study was carried out to determine the relationship between nadir hematocrit during CPB and postoperative hyperglycemia in nondiabetic patients.</p><p><b>Methods:</b> Records of 200 nondiabetic patients undergoing coronary artery bypass grafting operation were retrospectively reviewed. In the first analysis, patients were divided into two subgroups according to the presence or absence of hyperglycemia. Further analysis was made after dividing the patients into 3 subgroups according to nadir hematocrit levels on CPB (less than 20%; 20% to 25%; greater than or equal to 25%).</p><p><b>Results:</b> Compared to patients without hyperglycemia, patients with postoperative hyperglycemia had significantly lower preoperative hematocrit levels (p = 0.004) and were associated with lower nadir hematocrit levels during CPB (p= 0.002). Peak intensive care unit blood glucose levels and number of blood transfusions were significantly higher in patients with nadir hematocrit levels less than 20. (p<0.001 and p<0.001 respectively). Logistic regression analysis demonstrated that nadir hematocrit levels less than 20% (OR 2.9, p=0.009) and allogenic blood transfusion (OR 1.5, p=0.003) were independently associated with postoperative hyperglycemia.</p><p><b>Conclusions:</b> Nadir hematocrit levels on CPB less than 20% and allogenic blood transfusions were independently associated with postoperative hyperglycemia in nondiabetic patients. Patients with a nadir hematocrit levels less than 20 % during CPB should be closely monitored for hyperglycemia in the perioperative period.</p>

scholarly journals Effectiveness and safety of tranexamic acid in total joint arthroplasty

2019 ◽  
Vol 29 (11) ◽  
pp. 356-360
Author(s):  
Khaled M. Yaghmour ◽  
Sam Atkinson ◽  
Emanuele Chisari ◽  
Stephen M. McDonnell ◽  
Wasim Khan
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Blood Transfusions

Total joint arthroplasty is associated with significant blood loss, that could result in the need of blood transfusions. Several techniques are being utilised to limit the volume of blood loss, in order to avoid transfusion. In this review, we look at blood loss in total joint arthroplasty and the perioperative strategies to limit the loss of blood. With the use of tranexamic acid gaining popularity, we analyse the published literature on its use in patients undergoing total joint arthroplasty. We have found that published studies favour using tranexamic acid in total joint arthroplasty as a safe and effective method of reducing blood loss.

Who Is Still Receiving Blood Transfusions After Primary and Revision Total Joint Arthroplasty?

2021 ◽  
Author(s):  
David E. DeMik ◽  
Christopher N. Carender ◽  
Natalie A. Glass ◽  
Timothy S. Brown ◽  
John J. Callaghan ◽  
...  
Keyword(s):  
Total Joint Arthroplasty ◽  
Joint Arthroplasty ◽  
Blood Transfusions ◽  
Revision Total Joint Arthroplasty

scholarly journals Fluctuation of fasting blood glucose in patients who underwent primary or revision total joint arthroplasty: a retrospective review

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yongyu Ye ◽  
Baiqi Pan ◽  
Minghui Gu ◽  
Guoyan Xian ◽  
Weishen Chen ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Total Joint Arthroplasty ◽  
Medical Records ◽  
Fasting Blood Glucose ◽  
Glycemic Variability ◽  
Perioperative Period ◽  
Joint Arthroplasty ◽  
Primary Group ◽  
Diabetic Patients ◽  
Revision Total Joint Arthroplasty

Abstract Background Perioperative hyperglycemia is a risk factor for postoperative complications after total joint arthroplasty (TJA). However, the variability of fasting blood glucose (FBG) after TJA remains unknown. We aimed to assess the fluctuation and extent of elevation of FBG following primary or revision TJA. Methods We retrospectively evaluated the medical records of 1788 patients who underwent primary or revision TJA between 2013 and 2018. We examined FBG values collected during 6 days of the perioperative period. The findings for each time point were evaluated with descriptive statistics. Postoperative glycemic variability was assessed by the coefficient of variation (CV). Results The final cohort included the medical records of 1480 patients (1417 primary and 63 revision). FBG was highest on postoperative day 1 in the primary and revision groups (P < 0.001), which had the highest number of hyperglycemic patients (FBG > 100 mg/dL), with 66.4% and 75.5% in the primary and revision groups, respectively. The CV of diabetics in the primary group, and diabetics and non-diabetics in the revision group, was higher than that of non-diabetics in the primary group. Conclusion Postoperative day 1 showed the highest FBG levels and proportion of patients with hyperglycemia in the perioperative period. Primary group diabetics, and revision group diabetics and non-diabetics, had higher postoperative fluctuation of FBG than primary group non-diabetics. Frequent FBG monitoring may therefore be warranted in diabetic patients undergoing TJA, and all patients undergoing revision TJA.

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