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Perioperativer Einsatz der Tranexamsäure in der Endoprothetik

Perioperative use of tranexamic acid in endoprosthetic surgery

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Knie Journal Aims and scope

Zusammenfassung

Hintergrund

Eine adäquate Blutungsprophylaxe ist wichtig bei endoprothetischen Eingriffen, da ein erhebliches Risiko für intra- und postoperative Blutungen besteht. Tranexamsäure ist eine antifibrinolytische Substanz, die zur Behandlung und Prävention einer Blutung verwendet wird.

Fragestellung

Welche Handlungsempfehlungen können bezüglich der Verwendung von Tranexamsäure in der Prävention relevanter Blutungen im Rahmen endoprothetischer Eingriffe getroffen werden?

Material und Methoden

Es erfolgte eine systematische Literaturrecherche in den Datenbanken PubMed und Cochrane Library über den Publikationszeitraum 2000 bis 2018 mit den Suchtermini (tranexamic acid[Title]) AND knee arthroplasty[Title/Abstract]. Es wurden die Studien ausgewählt, die systematische Übersichtsarbeiten, Metaanalysen oder randomisiert kontrollierte Studien beinhalten.

Ergebnisse

Mehrere Metaanalysen zeigen, dass die perioperative Verwendung von Tranexamsäure in der Endoprothetik die Blutungsmenge sowie den Transfusionsbedarf deutlich senken kann. Komplikationen sind selten und zeigen keine erhöhte Inzidenz im Vergleich zur Kontrolle. Komplikationen sind thromboembolische Ereignisse und Krampfanfälle, allerdings schließen die meisten Studien Patienten mit einer Vorgeschichte thromboembolischer Ereignisse aus, sodass besondere Vorsicht walten muss.

Diskussion

Die Verwendung von Tranexamsäure in der Endoprothetik reduziert Blutungen und die Wahrscheinlichkeit einer Transfusion. Eine Berücksichtigung individueller Risiken und eine sorgfältige Indikationsstellung sind vor dem Hintergrund des „off-label use“ in Deutschland unabdingbar. Die American Association of Hip and Knee Surgeons weist darauf hin, dass unabhängig von dem Applikationsweg intravenös, topisch oder oral eine gleichwertige Blutungsprophylaxe zu erzielen ist. Laut Empfehlung der AE der Deutschen Gesellschaft für Endoprothetik kann eine präoperative intravenöse Gabe einzeln und/oder in Kombination mit einer intraartikulären Gabe erwogen werden.

Abstract

Background

Prevention of severe bleeding is critical for sufficient patient blood management because endoprosthetic surgery is associated with a substantial risk for intraoperative and postoperative bleeding. Tranexamic acid is a synthetic, antifibrinolytic agent, which is used for the treatment and prevention of bleeding.

Purpose

Which recommendations for action can be made with respect to the use of tranexamic acid in the prevention of relevant bleeding in patients undergoing total knee arthroplasty?

Material and methods

A systematic search was carried out in the PubMed and Cochrane Library databanks using the search terms tranexamic acid [title] AND knee arthroplasty [title/abstract] in the years 2000–2018. This study is based on the selected systematic reviews, meta-analyses and randomized controlled trials.

Results

Several meta-analyses could show that the perioperative use of tranexamic acid in endoprosthetic surgery can significantly decrease the extent of blood loss and the need for transfusions. Complications were rare and the incidence did not significantly differ from control groups. Thromboembolic events and seizures should be mentioned as possible clinical complications, especially since most studies excluded patients with a known history of thromboembolic events.

Conclusion

The perioperative administration of tranexamic acid in endoprosthetic surgery reduces blood loss and the probability of a transfusion. An individual risk assessment and a thorough clinical assessment of the indications are essential especially against the background of the off-label use in Germany. The guidelines of the American Association of Hip and Knee Surgeons confirm that intravenous, topical and oral administration are equally effective for prophylactic bleeding control. According to the recommendations of the AE – German Society for Endoprosthetic Surgery a preoperative intravenous administration alone and/or in combination with intra-articular administration can be considered.

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Authors and Affiliations

  1. Klinik und Poliklinik für Orthopädie, Klinikum rechts der Isar, MRI, TU München, Ismaninger Str. 22, 81675, München, Deutschland

    Igor Lazic, Alexander T. Haug & Rüdiger von Eisenhart-Rothe

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  1. Igor Lazic
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  3. Rüdiger von Eisenhart-Rothe
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Correspondence to Igor Lazic.

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I. Lazic, A.T. Haug und R. von Eisenhart-Rothe geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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R. von Eisenhart-Rothe, München

R. Hube, München

W. Petersen, Berlin

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Lazic, I., Haug, A.T. & von Eisenhart-Rothe, R. Perioperativer Einsatz der Tranexamsäure in der Endoprothetik. Knie J. 2, 3–8 (2020). https://doi.org/10.1007/s43205-020-00042-3

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