Effectiveness and safety of an optimized blood management program in total hip and knee arthroplasty: A large, single-center, retrospective study

Abstract

Little has been published on blood management in total hip and knee arthroplasty (THA and TKA, respectively) patients focusing on both hematopoiesis and hemostasis. Our aim was to explore the effectiveness and safety of an optimized blood management program in THA and TKA patients in a large, single-center, retrospective study.We retrospectively reviewed consecutive primary unilateral THA and TKA patients' data at our institution through the National Health Database. They were divided into 3 groups according to an optimized blood management program: group A-combined use of intravenous and topical tranexamic acid (TXA); group B-use of recombinant human erythropoietin (rHuEPO) and iron supplements in addition to treatments in group A; group C-use of additional multiple boluses of TXA in addition to treatments in group B. The primary outcomes were hemoglobin (Hb) drop and calculated total blood loss (TBL). Other outcome measurements such as transfusion rate, postoperative length of stay (PLOS), venous thromboembolism (VTE), and mortality were also compared.From 2014 to 2016, a total of 1907 unilateral THA (986 in group A, 745 in group B, and 176 in group C) and 1505 unilateral TKA (795 in group A, 556 in group B, and 154 in group C) procedures were conducted at our institution. The Hb drop, calculated TBL, and PLOS in group C were significantly lower than those in groups A and B for THA and TKA patients. The transfusion rate in group C was also significantly less than in groups A and B for THA patients, while it was similar in groups A and B for TKA patients. No patients in group C received a transfusion. A significant difference was not detected in the incidence of deep vein thrombosis. No episode of symptomatic pulmonary embolism or all-cause mortality occurred within 30 days postoperatively.The current retrospective study suggests that for patients receiving primary unilateral THA or TKA, multiple boluses of intravenous TXA combined with topical TXA, rHuEPO, and iron supplements can reduce the calculated TBL, Hb drop, transfusion rate, and PLOS without increasing the incidence of VTE or mortality.

Figure 1

The regimen of rHuEPO and iron supplement therapy for patients in group B and C. Hb = hemoglobin, rHuEPO = recombinant human erythropoietin, THA = total hip arthroplasty, TKA = total knee arthroplasty.

Figure 2

The level of Hb in THA (A) and TKA patients (B). Hb = hemoglobin, POD1 = postoperative day 1, POD3 = postoperative day 3, Pre = preoperatively, THA = total hip arthroplasty, TKA = total knee arthroplasty.

Figure 3

The Hb drop in THA (A) and TKA patients (B). Hb = hemoglobin, POD1 = postoperative day 1, POD3 = postoperative day 3, THA = total hip arthroplasty, TKA = total knee arthroplasty. ^∗Means P value <0.05, ^∗∗means P value <0.01.