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Hemostatic techniques to reduce blood transfusion after primary TKA: a meta-analysis and systematic review
Dong Z, Han L, Song Y, Qi J, Wang F
Archives of orthopaedic and trauma surgery. 2019
Abstract
PURPOSE To investigate the efficacy of non-tranexamic acid (TXA) on reducing blood loss and requirements of allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA). METHODS The PubMed, EMBASE, and the Cochrane Library databases were researched since incipiency to June 2018. Only randomized controlled trials (RCTs) involved with non-TXA hemostatic techniques in TKA met the inclusion criteria. RESULTS A total of 36 RCTs, including 1511 patients, were recruited for analysis. The results of subgroup analysis revealed that hemostatic techniques, which could substantially decrease the rate of ABT, were cell salvage with the transfusion trigger of 9 mg/dl, fibrin sealant with a dosage of 10 ml, and postoperative flexion position. CONCLUSION The available evidence in this meta-analysis suggests that postoperative flexion position, fibrin sealant, and cell salvage can substantially decrease the rate of ABT in TKA. Further studies, including more hemostatic methods and high-quality research, are expected.
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2.
Combined use of intravenous and topical versus intravenous tranexamic acid in primary total knee and hip arthroplasty: a meta-analysis of randomised controlled trials
Li JF, Li H, Zhao H, Wang J, Liu S, Song Y, Wu HF
Journal of Orthopaedic Surgery and Research. 2017;12((1)):22.
Abstract
BACKGROUND This meta-analysis aimed to evaluate the efficiency and safety of combined intravenous and topical methods of application versus single intravenous of tranexamic acid in primary total knee and hip arthroplasty. METHODS A systematic search was carried out in MEDLINE (from 1966 to 25 September 2016), PubMed (from 1966 to 25 September 2016), Embase (from 1980 to 25 September 2016), ScienceDirect (from 1985 to 25 September 2016) and the Cochrane Library. Only high-quality randomised controlled trials (RCT) were identified. Two authors independently performed data extraction and quality assessment of included studies. Meta-analysis was conducted using Review Manager 5.1 software. RESULTS Six RCTs that included 687 patients met the inclusion criteria. The present meta-analysis indicated that there were significant differences in terms of total blood loss (MD = -193.59, 95% CI -338.06 to -49.13, P = 0.009), transfusion rate (RD = -0.07, 95% CI -0.12 to -0.03, P = 0.001), haemoglobin decline (MD = -0.51, 95% CI -0.83 to -0.18, P = 0.01) and length of stay (MD = -0.20, 95% CI -0.38 to -0.02, P = 0.03) between groups. CONCLUSIONS Combined administration of tranexamic acid (TXA) in patients with total knee and hip arthroplasty was associated with significantly reduced total blood loss, transfusion requirements, postoperative haemoglobin decline and length of stay compared to single application alone but was not associated with prolonged operation time. Moreover, no adverse effects, such as superficial infection, deep vein thrombus (DVT) or pulmonary embolism (PE), were associated with TXA. We suggest that combined administration of TXA demonstrated excellent clinical efficacy and safety in patients with total knee and hip arthroplasty. More importantly, well-designed studies with larger sample size are needed to provide further reliable evidence for the combined use of TXA.
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3.
The effect of Chinese herbal medicine on hemorrhagic shock: a systematic review and meta-analysis
Wang DL, Lu XG, Guo WX, Chen T, Song Y, Fan ZW
Complementary Therapies in Medicine. 2016;29:78-88.
Abstract
BACKGROUND Chinese herbal medicine (CHM) has been widely used in the treatment of hemorrhagic shock (HS) in China. Many controlled trials have been undertaken to investigate its efficacy. OBJECTIVE To evaluate the effectiveness and safety of CHM for Hemorrhagic Shock patients. METHODS We screening the Web of ScienceDirect database, PubMed, the Cochrane Library, EMBASE, China Biomedical Database web (CBM), China National Knowledge Infrastructure (CNKI) and WanFang database (WF), from inception to January 2015. All the randomized controlled trials (RCTs) that compared CHM plus conventional therapy with conventional therapy alone for HS patients were included. Meta-analysis on included studies was performed using fixed-effects model with RevMan 5.2. Risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI) was used as effect measure. STATA 12.0 was used for publication bias. RESULTS Fifteen RCTs involving 1076 participants were included in the meta-analysis. CHM combined with conventional therapy was tested to be more effective in reduce mortality (RR=0.24, 95%CI:0.13-0.46, P<0.0001), reduce the incidence of MODS (RR=0.47, 95%CI: 0.34-0.66,P<0.00001), symptomatic improvement: increase blood pressure (BP) (MD=8.83, 95%CI:6.82-10.84,P<0.00001), regulate heart rate (MD=-7.6,95%CI:-9.17 to -6.02,P<0.00001), increase urine volume (MD=7.26, 95%CI:5.00-9.53, P<0.00001), compared with conventional therapy alone. No serious adverse events were reported. CONCLUSIONS CHM combined with conventional therapy seems to be more effective on HS patients. However, the analysis results should be interpreted with caution due to the low methodological quality of the included trials. Future, the rigorously designed, high methodological quality, multicenter and large-scale trials are needed to confirm these conclusions.
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4.
Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study
Wei LC, Lei GH, Sheng PY, Gao SG, Xu M, Jiang W, Song Y, Luo W
Journal of Orthopaedic Research. 2012;30((10):):1570-6.
Abstract
To investigate whether platelet-rich plasma (PRP) when used with allograft bone improves the management outcome of displaced intra-articular calcaneal fractures. Over a 7-year period, all displaced type III calcaneal fractures admitted in our department (276 fractures in 254 patients) were randomly divided into three groups according to the plan of management: autograft alone (n = 101), allograft combined with PRP (n = 85), or allograft alone (n = 90). Radiographic imaging and three-dimensional computed tomography were used to assess the thalamic portion, Bohler's angle, the crucial angle of Gissane, and the height, width and length of the calcaneum. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind-foot scoring system was used to evaluate the hind foot function at 12, 24, and 72 months postsurgery. At 12 months no significant difference existed in outcome amongst the treatment groups (p > 0.05). However, at 24 and 72 months the results of the autograft, and the allograft combined with PRP, were similar and both were significantly better than that of the allograft alone (p < 0.05). PRP augmented the favorable outcome of allografts in the management of displaced calcaneal fractures, and matched that of autograft used alone. The findings of this study thus support the clinical use of PRP in conjunction with allograft in the treatment of displaced intra-articular calcaneal fractures. Copyright 2012 Orthopaedic Research Society.
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5.
Effects of blood washing and autotransfusion during cardiopulmonary bypass on erythrocyte immune and kidney function
Song Y, Li R, Gu XH, Gong XJ, Zhang G, Wu SM, Zhang XQ, Li SX
Zhonghua Yi Xue Za Zhi. 2006;86((32):):2293-6.
Abstract
OBJECTIVE To study changes of erythrocyte immune and kidney function after autotransfusion washed red blood cells during cardiopulmonary bypass (CPB). METHODS Thirty-two patients undergoing valve replacement with CPB were randomly divided into study group and control group (16 in each group). In study group, the blood in operative field and the residual blood in the extracorporal machine were collected, centrifuged, washed and retransfused to patients. Patients in control group were transfused with the residual blood in the extracorporal machine without any disposal or banked blood. All patients were used with membrane oxygenator. Before CPB, 12 h, 24 h, 72 h and 7 d after CPB, whole blood were taken, then the erythrocyte immune function (C3bRR, RICR) and level of plasma free hemoglobin (FHB) were assayed, and post-operation renal function was compared between the two groups. Moreover, total volume of banked blood transfused to patients after CPB was recorded. RESULTS (1) After 12 hours, 24 hours, 72 hours, 7 days of CPB, the RBC-C3bRR (14. 3% +/- 4. 7%, 15. 9% +/- 3. 6%, 16. 6% +/- 2. 8%, 19. 9% +/- 4. 1%) and RBC-ICR (8. 7% +/- 1. 9%, 9. 2% +/- 2. 0%, 9. 5% +/- 2. 6%, 12. 0% +/- 2. 0%) in study group were significantly elevated than that in control group (RBC-C3bRR 10. 7% +/- 2. 4%, 11. 3% +/- 3. 0%, 12. 3% +/- 3. 5%, 14. 5% +/- 2. 0%, RBC-ICR 5. 9% +/- 1. 4%, 6. 0% +/- 1. 8%, 7. 0% +/- 1. 7%, 8. 7% +/- 2. 7%). The erythrocyte immune function after CPB was better and restored faster in study group than that in control group (P < 0. 05 in all). (2) After 12 hours, 24 hours of CPB, the levels of FHB (0. 41 g/L +/- 0. 13 g/L, 0. 03 g/L +/- 0. 02 g/L) in study group were significantly lower than that in control group (1. 02 g/L +/- 0. 23 g/L, 0. 54 g/L +/- 0. 09 g/L) (P < 0. 01). After 24 hours of CPB, the level of urinary protein excretion (0. 19 g/d +/- 0. 08 g/d) in study group was significantly lower than that in control group (0. 32 g/d +/- 0. 07 g/d) (P < 0. 05). (3) After 24 hours of CPB, the level of 24 h creatinine clearance was significantly elevated in study group (68 ml x min(-1) x 1. 73 m(-2) +/- 10 ml x min(-1) x 1. 73 m(-2)) than that in control group (45 ml x min(-1) x 1. 73 m(-2) +/- 4 ml x min(-1) x 1. 73 m(-2)) (P < 0. 01). (4) The total volume of banked RBCs transfused after CPB were fewer in study group (2. 0 U +/- 1. 1 U) than that in control group (7. 4 U +/- 2. 3 U) (P < 0. 01). CONCLUSION Autotransfusion of washed red blood cells during CPB may improve significantly the erythrocyte immune function and protect kidney function better than transfusion of residual blood in the extracorporal machine or banked blood.