[Acute normovolemic hemodilution combined with inhibition of fibrinolysis and use of cell saver in total hip arthroplasty].
BACKGROUND
Transfusion with homologous blood is not without costs for the recipient: An increased risk of postoperative infections must be anticipated, and the risk of transfusion-transmitted viral infections is of growing concern. This has increased the interest for methods which can reduce the need for intraoperative blood transfusion. The goal of this study was to determine if acute normovolemic hemodilution combined with fibrinolytic inhibition and the use of cell saver can reduce the need for homologous blood transfusion in total hip arthroplasty compared to the cellsaver technique alone.


METHODS
145 patients undergoing total hip arthroplasty in spinal anesthesia were included in the study. They were all operated by the same surgeon. In group A (N = 64) only the cell saver was used, whereas in group B (N = 81) it was combined with acute normovolemic hemodilution and use of the fibrinolytic inhibitor tranexamic acid.


RESULTS
The total blood loss and the need for homologous blood transfusion were significantly smaller in group B than in group A.


CONCLUSIONS
Although the cell saving technique is effective in total hip arthroplasty, this study demonstrates that a further reduction of blood loss and homologous blood transfusion can be achieved by combining the method with acute normovolemic hemodilution and pharmacological inhibition of fibrinolysis.
Øberg
Bjarne L
BL
Erichsens Klinik, Charlottenlund.
Lauritsen
Anne Ø
AØ
Gravesen
Henning S
HS
Erichsen
Henrik
H
D000933:Antifibrinolytic Agents / Q000008:administration & dosage; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000706:statistics & numerical data; D001810:Blood Volume; D000075202:Contraindications; D005342:Fibrinolysis / Q000187:drug effects*; D006438:Hemodilution / Q000379:methods; D006801:Humans; D014148:Tranexamic Acid / Q000008:administration & dosage
D000933:Antifibrinolytic Agents; D014148:Tranexamic Acid