title: Comparative efficacy of different doses of fibrin sealant to reduce bleeding after total knee arthroplasty.
abstract: In recent years, the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis. We designed a prospective randomized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant (5 and 10 ml) in patients undergoing total knee arthroplasty, as compared with the untreated control group. A total of 90 patients entered the study, randomly assigned to one of the three groups: treatment with 5 ml fibrin sealant (30 patients), with 10 ml fibrin sealant (30 patients) or no treatment (30 patients). A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls: 5 ml fibrin sealant (2.6 mg/dl) and 10 ml fibrin sealant (2.5 mg/dl) vs. controls (3.7 mg/dl) (P = 0.024). The mean number of blood transfusions was significantly lower in the treated groups: 5 ml (0.5) and 10 ml (0.3) of fibrin sealant vs. controls (1) (P = 0.0019). Functional recovery was also better in the treated groups: on the seventh day, the joint ROM (range of motion) was statistically superior in the 5 ml group (96.5°) and 10 ml group (98.8°) as compared with the controls (75.5°) (P < 0.0001). This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature.
authors.affiliation: Orthopaedics Section, Department of Neuroscience and Organs of Sense, University General Hospital, Bari, Italy. angelanotarnicola@yahoo.it
authors.forename: Angela
authors.initials: A
authors.lastname: Notarnicola
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moretti
authors.forename: Antonio
authors.initials: A
authors.lastname: Martucci
authors.forename: Antonio
authors.initials: A
authors.lastname: Spinarelli
authors.forename: Silvio
authors.initials: S
authors.lastname: Tafuri
authors.forename: Vito
authors.initials: V
authors.lastname: Pesce
authors.forename: Biagio
authors.initials: B
authors.lastname: Moretti
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects / Q000379:methods; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007717:Knee / Q000601:surgery; D016015:Logistic Models; D008297:Male; D008875:Middle Aged
chemical_list: D015718:Fibrin Tissue Adhesive; D006454:Hemoglobins