title: Tranexamic Acid in a Multimodal Blood Loss Prevention Protocol to Decrease Blood Loss in Revision Total Knee Arthroplasty: A Cohort Study.
abstract: OBJECTIVE
  To clarify if blood loss and transfusion requirements can be decreased in revision knee surgery through a multimodal blood loss approach with tranexamic acid (TXA).
  
  
  METHODS
  A retrospective study was designed in 87 knees (79 patients) that received a knee revision between 2007 and 2013. To avoid heterogeneity in the surgical technique, only revisions with one single implant system were included. A treatment series of 44 knees that received TXA and other techniques in a multimodal blood loss protocol was compared to a control series of 43 knees that received neither TXA nor the rest of the multimodal blood loss protocol. No differences in the complexity of surgeries or case severity were detected.
  
  
  RESULTS
  A significant decrease was observed from 58% transfusion rate in the control group to 5% in the treated group. The postoperative haemoglobin drop was also significantly different. Although the use of a blood loss prevention approach including TXA was the most relevant factor in the transfusion risk (OR=15), longer surgical time also associated an increased risk of transfusion (OR=1.15).
  
  
  CONCLUSIONS
  This study supports the use of a two-dose intravenous TXA under a multimodal blood loss prevention approach in revision knee replacement with significant reduction in the transfusion rate, postoperative blood loss and haemoglobin drop.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-Cantoblanco, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Ortega-Andreu
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-Cantoblanco, Madrid, Spain.
authors.forename: Gloria
authors.initials: G
authors.lastname: Talavera
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ-UAM, Madrid, Spain.
authors.forename: Norma G
authors.initials: NG
authors.lastname: Padilla-Eguiluz
authors.affiliation: Department of Orthopaedic Anaesthesiology, Hospital La Paz-Cantoblanco, Madrid, Spain.
authors.forename: Hanna
authors.initials: H
authors.lastname: Perez-Chrzanowska
authors.affiliation: Department of Orthopaedic Anaesthesiology, Hospital La Paz-Cantoblanco, Madrid, Spain.
authors.forename: Reyes
authors.initials: R
authors.lastname: Figueredo-Galve
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ-UAM, Madrid, Spain.
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rodriguez-Merchán
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital La Paz-IdiPAZ-UAM, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Gómez-Barrena
keywords: Blood loss; Blood saving protocol; Haemoglobin drop; Multimodal protocol; Revision knee replacement; Revision total knee replacement; Tranexamic acid; Transfusion rate