Clinical effects of erythropoietin combined with iron and tranexamic acid on perioperative blood loss in total knee arthroplasty

LEI Yi-ting; HUANG Qiang; CAO Guo-rui; ZHANG Shao-yun; XU Bin; PEI Fu-xing

doi:10.3969/j.issn.2095-252X.2017.12.004

Abstract：Objective To evaluate clinical effects of the use of erythropoietin ( EPO ) and iron, combined with multiple-dose perioperative tranexamic acid in an enhanced recovery after surgery ( ERAS ) program for primary total knee arthroplasty ( TKA ). Methods A large, single-center, retrospective study was conducted in 1540 patients who underwent primary TKA from May 2014 to January 2017. Study samples were divided into 3 groups. Group A received a single dose of IV-TXA combined with topical application of TXA. Group B received erythropoietin and iron supplement on the basis of Group A. Group C received multiple-dose IV-TXA regimen on the basis of Group B. Total blood loss ( TBL ), maximum hemoglobin ( Hb ) drop, transfusion rate, length of hospital stay ( LOS ) and the incidence of thrombotic events were recorded and compared. Results The TBL and maximum Hb drop in Group C ( 636.95 ± 285.03 ) ml, ( 20.62 ± 9.83 ) g / L were significantly lower than those in Group B ( 824.18 ± 385.09 ) ml, ( 25.37 ± 14.11 ) g / L and Group A ( 932.64 ± 351.00 ) ml, ( 28.91 ± 15.02 ) g / L ( P < 0.001 ). The TBL and maximum Hb drop in Group B were also lower than those in Group A ( P < 0.001 ). The transfusion rate were 2.96%, 2.40% and 0.45% in Groups A, B, and C, which showed a downward tendency, however, the differences were not statistically significant ( P = 0.097 ). LOS in Group C ( 9.92 ± 3.17 ) days was shorter than Group B ( 11.57 ± 3.84 ) days and A ( 12.00 ± 3.87 ) days ( P < 0.001 ). The intramuscular venous thrombosis frequencies were 61, 45 and 18 in Group A, B, and C, and the differences were not statistically significant ( P = 0.956 ). Eleven patients in Group A, 9 in Group B, 2 in Group C developed deep venous thrombosis and the differences did not reach statistical significance ( P = 0.801 ). Furthermore, no episodes of pulmonary embolism occurred in all cases. Conclusions Application of EPO and iron could effectively reduce TBL, diminish the maximum Hb drop in patients following ERAS primary TKA. The multiple-dose TXA regimen can further reduce the blood loss, ameliorate anemia and shorten LOS on the basis of EPO and iron therapy, without increasing the risk of thrombosis events.