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Abstract(s)
Enquadramento: O ácido tranexâmico (TXA) é um agente anti-fibrinolítico normalmente utilizado para reduzir a perda de sangue e da necessidade de recorrer a transfusões na artroplastia total primária da anca e do joelho, contribuindo para um menor tempo de internamento e recuperação mais célere.
Objetivos: Evidenciar a eficácia do protocolo de administração profilática do ácido tranexâmico em pessoas submetidas a artroplastia total primária do joelho e anca.
Métodos: Revisão sistemática da literatura realizada através da metodologia PRISMA, tendo por base os critérios PICO. A busca foi realizada nos bancos de dados PubMed e Web of Science, usando uma expressão de busca baseada nos seguintes termos MeSH: arthroplasty" AND ((Arthroplasty, Replacement, Hip) OR ((Arthroplasty, Replacement, Knee)) AND "tranexamic acid" AND "hemostatics" OR Hemostatics” (287 artigos). Após leitura, análise e aplicação dos critérios de inclusão estabelecidos resultaram 4 artigos que foram integrados neste estudo. Aplicadas as orientações da JBI à metodologia PRISMA tendo em conta os critérios PICO.
Resultados: As evidências dos estudos revelam que o TXA possui um antifibrinolítico no campo cirúrgico devido à acumulação no espaço extracelular. Todavia, não tem efeito sistémico de ação e, por conseguinte, não impedirá a formação de coágulos noutras zonas. O TXA não foi associado a um risco acrescido de trombose venosa profunda ou embolia pulmonar. A utilização profilática do TXA é igualmente eficaz na redução de hemorragias na ATA e na ATJ. Ambas as cirurgias tiveram um efeito semelhante na fibrinólise. O TXA, administrado na mesma dose, consegue uma redução comparável na hemorragia em doentes submetidos a ARA e ATJ. As alterações nos parâmetros de fibrinólise são semelhantes em ambas as cirurgias e isto pode explicar porque é que a mesma dose de TXA leva a uma redução semelhante na hemorragia.
Conclusão: Os resultados obtidos sugerem que as grandes cirurgias ortopédicas estimulam o sistema de fibrinólise e que o TXA pode neutralizar parcialmente este efeito, tanto local como sistemicamente.
Palavras-chave: Artoplastia primária total da anca; Artoplastia primária total do joelho; ácido tranexâmico.
Abstract Background: Tranexamic acid (TXA) is an anti-fibrinolytic agent commonly used to reduce blood loss and the need for transfusions in primary total hip and knee arthroplasty, contributing to a shorter hospital stay and faster recovery. Objectives: To demonstrate the efficacy of a prophylactic tranexamic acid administration protocol in people undergoing primary total knee and hip arthroplasty. Methods: Systematic literature review using the PRISMA methodology, based on the PICO criteria. The search was performed in PubMed and Web of Science databases using a search expression based on the following MeSH terms: arthroplasty" AND ((Arthroplasty, Replacement, Hip) OR ((Arthroplasty, Replacement, Knee)) AND "tranexamic acid" AND "hemostatics" OR Hemostatics" (287 articles). After reading, analysis and application of the established inclusion criteria, 4 articles resulted that were integrated in this study. Applied the JBI guidelines to the PRISMA methodology taking into account the PICO criteria. Results: Evidence from the studies reveals that TXA has an antifibrinolytic effect in the surgical field due to accumulation in the extracellular space. However, it has no systemic effect of action and therefore will not prevent clot formation in other areas. TXA has not been associated with an increased risk of deep vein thrombosis or pulmonary embolism. The prophylactic use of TXA is equally effective in reducing bleeding in ATA and TKA. Both surgeries had a similar effect on fibrinolysis. TXA, given at the same dose, achieves a comparable reduction in bleeding in patients undergoing both ATA and TKA. The changes in fibrinolysis parameters are similar in both surgeries and this may explain why the same dose of TXA leads to a similar reduction in bleeding. Conclusion: The results obtained suggest that major orthopedic surgeries stimulate the fibrinolysis system and that TXA can partially counteract this effect, both locally and systemically. Keywords: Primary total hip arthroplasty; Primary total knee arthroplasty; tranexamic acid.
Abstract Background: Tranexamic acid (TXA) is an anti-fibrinolytic agent commonly used to reduce blood loss and the need for transfusions in primary total hip and knee arthroplasty, contributing to a shorter hospital stay and faster recovery. Objectives: To demonstrate the efficacy of a prophylactic tranexamic acid administration protocol in people undergoing primary total knee and hip arthroplasty. Methods: Systematic literature review using the PRISMA methodology, based on the PICO criteria. The search was performed in PubMed and Web of Science databases using a search expression based on the following MeSH terms: arthroplasty" AND ((Arthroplasty, Replacement, Hip) OR ((Arthroplasty, Replacement, Knee)) AND "tranexamic acid" AND "hemostatics" OR Hemostatics" (287 articles). After reading, analysis and application of the established inclusion criteria, 4 articles resulted that were integrated in this study. Applied the JBI guidelines to the PRISMA methodology taking into account the PICO criteria. Results: Evidence from the studies reveals that TXA has an antifibrinolytic effect in the surgical field due to accumulation in the extracellular space. However, it has no systemic effect of action and therefore will not prevent clot formation in other areas. TXA has not been associated with an increased risk of deep vein thrombosis or pulmonary embolism. The prophylactic use of TXA is equally effective in reducing bleeding in ATA and TKA. Both surgeries had a similar effect on fibrinolysis. TXA, given at the same dose, achieves a comparable reduction in bleeding in patients undergoing both ATA and TKA. The changes in fibrinolysis parameters are similar in both surgeries and this may explain why the same dose of TXA leads to a similar reduction in bleeding. Conclusion: The results obtained suggest that major orthopedic surgeries stimulate the fibrinolysis system and that TXA can partially counteract this effect, both locally and systemically. Keywords: Primary total hip arthroplasty; Primary total knee arthroplasty; tranexamic acid.
Description
Keywords
Ácido tranexâmico Antifibrinolíticos Artroplastia da anca Artroplastia do joelho Hemostáticos Revisão sistemática Antifibrinolytic agents Arthroplasty, replacement, hip Arthroplasty, replacement, knee Hemostatics Systematic review Tranexamic acid