title: Use of a haemostatic matrix (Floseal®) does not reduce blood loss in minimally invasive total knee arthroplasty performed under continued aspirin.
abstract: BACKGROUND
  Aspirin is being used for primary and secondary cardiovascular prevention. It has been proposed that aspirin should be discontinued 5 to 7 days before surgery. However, discontinuation might increase the risk of cardiac and thrombo-embolic co-morbidity. Aspirin also increases the risk of bleeding during and after total knee arthroplasty. This study evaluated if the intra-articular use of a haemostatic matrix (Floseal®) might decrease blood loss in total knee arthroplasty performed under continued aspirin use.
  
  
  METHODS
  We retrospectively compared matched pairs in two groups (80 patients in each group). Patients in both groups were taking aspirin: one group was managed with conventional haemostasis (with bovie electrocoagulation), while the other group was treated with an intra-articular haemostatic matrix as an adjunct to electrocoagulation. The outcomes compared were haemoglobin and haematocrit levels at days 2 and 4 after surgery as surrogates for blood loss, transfusion rate, surgical time, and length of stay in the hospital.
  
  
  RESULTS
  No differences were observed between the two groups for haemoglobin and haematocrit levels on days 2 and 4. There were no differences in transfusion rate, surgical time or length of stay in hospital between the two groups.
  
  
  CONCLUSIONS
  The present study shows that the use of Floseal® has no effect on reducing either visible or hidden blood loss after total knee arthroplasty with peri-operative continuation of aspirin use, as assessed by a drop in haemoglobin or haematocrit.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Saint Luc-UCL, Brussels, Belgium.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Schwab
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Saint Luc-UCL, Brussels, Belgium.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Thienpont
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee; D001241:Aspirin / Q000008:administration & dosage*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D012189:Retrospective Studies
chemical_list: C411004:FloSeal Matrix; D001241:Aspirin