Lower transfusion trigger, preoperative autologous blood donation with or without erythropoietin, intraoperative red blood cell salvage, regional anesthesia, controlled hypotension, and antifibrinolytic agents have all been recommended as useful means to decrease the need for allogenic transfusions. Antifibrinolytic therapy constitutes an effective method to control or reduce bleeding and to limit or avoid blood transfusion in current medical practice. The prophylactic, i.e., preincisional, administration of aprotinin and tranexamic acid (TA) can reduce bleeding and allogeneic blood use in cardiopulmonary bypass surgery and total hip replacement surgery. Acute normovolemic hemodilution (ANH) is a potentially useful blood conservation strategy. Sixty patients undergoing THR were investigated in a clinical, randomized study. All patients had spinal anesthesia with 10 mg (2 ml) of hyperbaric 0.5% bupivacaine for the surgery and intrathecal morphine 0.1 mg for postoperative pain analgesia. Patients were randomly allocated to receive either TA (Group TA) acute normovolemic hemodilution (Group ANI1).or a placebo (Group P). In Group (TA). TA was given immediately before the surgery. After a test dose of lml„ patients received a dose of 10 mg/kg iv followed by an infusion of 1 ing/kg/hr dissolved in 1 L of saline for 10 hours (maximum I g/10 hours). Patients in Group P received an equivalent volume of physiologic saline. Patients in Group (AN11 1) while in the OR holding area. the patients were bled through a 16-gauge needle placed in the antecubital fossa with gravity drainage, to limit shear effects on the platelets. to a target hematocrit of approximately 28%. approximately. Intraoperative and postoperative blood losses were measured. Statistical analysis was performed using Student's t test for parametric data, We used the Mann-Whitney test (two-tailed) to compare all unpaired data (pre-, postoperative and total blood loss, number of blood transfusions, levels of hematocrit). The chi-square test was used to compare the number of patients receiving blood transfusions. lntraoperative bleeding was decreased from 635 ±223 in group P to 3351130 mL and 3601110 in groups TA and ANH respectively (P |
