title: [Perioperative management based on kinetics of bleeding during total primary arthroplasty].
abstract: BACKGROUND
  Management of the perioperative hemorrhagic risk is of major interest in patients undergoing total arthroplasty of the lower limb. Anemia in the postoperative period of that increasingly performed surgery carries its own morbidity and mortality. Better anticipation of its occurrence could be done with a refined knowledge of bleeding kinetics.
  
  
  METHODS
  We conducted a retrospective study in a single centre on 451 consecutive patients undergoing elective unilateral primary total hip or knee arthroplasty for osteoarthritis. Volume of total blood loss according to Mercuriali's formula and variations of haemoglobin levels were calculated between day 0 (D0) and postoperative day 8 (D8), and during subdivided periods between D0-D1, D1-D3 and D3-D8. Frequency and volume of autologous and homologous blood transfusions were also analyzed. Comparisons were done taking into account the use of intraoperative tranexemic acid (TA).
  
  
  RESULTS
  Seventy to 75% of blood loss occurred between D0 and D1. Bleeding occurred mostly between the end of surgery and morning of D1, and tended to stop at D3. TA significantly reduced blood loss in the first 3days, mostly after knee prosthesis surgery. However, the bleeding kinetics were the same with or without TA.
  
  
  CONCLUSIONS
  Loss of haemoglobin occurred mostly in the early postoperative period. To avoid transfusion delays, haemoglobin levels should be monitored regularly until the third postoperative day after total arthroplasty, especially when D1 haemoglobin is close to the transfusion threshold. Furthermore, our results support the routine use of TA.
authors: Service d'anesthésie-réanimation 2, hôpital Timone adulte, Assistance publique-Hôpitaux de Marseille, 264, rue Saint-Pierre, 13005 Marseille, France. estelleirisson@gmail.com
authors: E
authors: E
authors: Irisson
authors: F
authors: F
authors: Kerbaul
authors: S
authors: S
authors: Parratte
authors: Y
authors: Y
authors: Hémon
authors: J-N
authors: JN
authors: Argenson
authors: N
authors: N
authors: Rosencher
authors: L
authors: L
authors: Bellamy
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000706:statistics & numerical data; D000775:Anesthesia, Spinal / Q000706:statistics & numerical data; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000503:physiopathology / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data; D001804:Blood Transfusion, Autologous / Q000295:instrumentation; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007501:Iron / Q000008:administration & dosage / Q000627:therapeutic use; D007660:Ketoprofen / Q000008:administration & dosage / Q000627:therapeutic use; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D019106:Postoperative Hemorrhage / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D011292:Premedication; D011300:Preoperative Care; D012189:Retrospective Studies; D013566:Sympathomimetics / Q000627:therapeutic use; D013997:Time Factors; D014148:Tranexamic Acid / Q000008:administration & dosage / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D006454:Hemoglobins; D006993:Hypnotics and Sedatives; D010975:Platelet Aggregation Inhibitors; D013566:Sympathomimetics; D014148:Tranexamic Acid; D007660:Ketoprofen; D007501:Iron