1
|
Matsuda S, Miyazaki M, Hirakawa M, Nagashima Y, Akase H, Kaku N. Dose Comparison of Flowable Gelatin Hemostatic Matrix for Bleeding Loss in Primary Total Knee Arthroplasty. Cureus 2024; 16:e64780. [PMID: 39156378 PMCID: PMC11329804 DOI: 10.7759/cureus.64780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Intraoperative and postoperative bleeding in total knee arthroplasty (TKA) affects postoperative outcomes. Although the hemostatic effect of a flowable gelatin hemostatic matrix (FGHM) is known across several surgical fields, its effectiveness on TKA remains controversial. This study aimed to compare the amount of bleeding across three groups treated with different doses of FGHM in TKA. Methods Overall, 122 knee joints of patients who underwent unilateral primary TKA were included and divided into three groups according to FGHM dose: absence of FGHM (control group, N=48), administration of 5 mL of FGHM (5 mL group, N=46), and administration of 8 mL of FGHM (8 mL group, N=38). Total hemoglobin (Hb) loss, drain output, hidden blood loss (HBL), calculated total blood loss (TBL) on the first postoperative day (POD1) and one week postoperatively (POD7), postoperative flexion angle at one week and discharge, and incidence of postoperative deep venous thrombosis (DVT) were assessed. Results At POD1, the mean total Hb losses were 6.3±3.1g (control group), 5.5±3.3g (5 mL group), and 5.3±2.5g (8 mL group), with no significant differences. At POD7, the mean Hb losses were 9.1±4.6g (control), 8.7±3.6g (5 mL), and 8.3±4.0g (8 mL), also with no significant differences. Mean drain outputs and HBLs showed no significant differences among groups. While there was a decreasing trend in TBL with higher FGHM doses, it was not statistically significant at either POD1 or POD7. There were no statistically significant differences in the mean postoperative flexion angle at POD7 or discharge among the groups (99.7±12.6°, 95.7±12.5°, 98.3±13.8° at POD7; 115.9±9.7°, 113.8±9.6°, 116.6±9.2° at discharge). Of these, only one patient in the 8 mL group developed proximal DVT. Conclusion Despite a trend towards decreased bleeding with FGHM, no significant differences were found among the three groups. However, the clinical utility of this hemostatic agent for reducing blood loss after primary TKA remains still unclear.
Collapse
|
2
|
Park JW, Kim TW, Chang CB, Han M, Go JJ, Park BK, Jo WL, Lee YK. Effects of Thrombin-Based Hemostatic Agent in Total Knee Arthroplasty: Meta-Analysis. J Clin Med 2023; 12:6656. [PMID: 37892794 PMCID: PMC10607432 DOI: 10.3390/jcm12206656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
The effectiveness of Floseal, a thrombin-based hemostatic matrix, in total knee arthroplasty (TKA) in minimizing blood loss and transfusion requirements remains a topic of debate. This meta-analysis aims to evaluate the up-to-date randomized controlled trials (RCTs) on the efficacy and safety of Floseal in TKA. A comprehensive search was conducted in electronic databases to identify relevant RCTs. The methodological quality of the included studies was assessed, and data extraction was performed. The pooled effect sizes were calculated using standardized mean difference (SMD) or odds ratios (OR) with 95% confidence intervals (CIs). Eight studies involving 904 patients were included in the meta-analysis. The use of a thrombin-based hemostatic agent significantly reduced hemoglobin decline (SMD = -0.49, 95% CI: -0.92 to -0.07) and the risk of allogenic transfusion (OR = 0.45, 95% CI: 0.25 to 0.81) but showed no significant difference in the volume of drainage or total blood loss. Funnel plots showed no evidence of publication bias. This meta-analysis provides robust evidence supporting the effectiveness of Floseal in reducing hemoglobin decline and transfusion in TKA. Further well-designed RCTs with longer follow-up periods are warranted to assess long-term efficacy and safety.
Collapse
Affiliation(s)
- Jung-Wee Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Tae Woo Kim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Orthopaedic Surgery, SMG-SNU Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| | - Minji Han
- Department of Health Science and Technology, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 08826, Republic of Korea;
| | - Jong Jin Go
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Byung Kyu Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea; (J.-W.P.); (C.B.C.); (J.J.G.); (B.K.P.)
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
| |
Collapse
|
3
|
Comparison of Effects of a Thrombin-Based Hemostatic Agent and Topical Tranexamic Acid on Blood Loss in Patients with Preexisting Thromboembolic Risk Undergoing a Minimally Invasive Total Knee Arthroplasty. A Prospective Randomized Controlled Trial. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2549521. [PMID: 33511201 PMCID: PMC7822658 DOI: 10.1155/2021/2549521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 11/25/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
Background The efficacy of a thrombin-based hemostatic agent (Floseal®) on reducing postoperative blood loss after total knee arthroplasty (TKA) was still unclear. The aim of our study was to conduct a prospective randomized controlled study to compare the blood conservation effects of Floseal® and topical TXA in patients with preexisting thromboembolic risk undergoing primary minimally invasive TKA. Methods Our power analysis of this study was based upon the following description, to obtain a statistical power of 0.90 and an alpha error of 0.05, 30 patients were required in each group. Therefore, we enrolled a total of 103 patients with at least one of the risk factors for thromboembolism who underwent unilateral primary minimally invasive TKA, and the participants were randomly divided into the topical TXA group (n = 34), receiving intra-articular injection of 3 g of TXA in 100 mL saline after TKA, the topical Floseal® group (n = 34), receiving 10 mL of Floseal® intra-articularily during surgery, and the placebo group (n = 35), receiving an intra-articular saline injection only. The total blood loss (TBL) and hemoglobin (Hb) drop were compared among the 3 groups. Results The TXA group had a lower TBL of 645 mL (227 to 1090) in comparison with 1145 mL (535 to 1942) in the Floseal® group and 1103 mL (424 to 1711) in the placebo (p < 0.001, respectively). The TBL was similar between the Floseal® group and the placebo group (p = 0.819). No patients in any group had symptoms of venous thromboemblism. Conclusion Our prospective randomized controlled study showed that intra-articular application of TXA was superior to hemostatic matrix (Floseal®) in terms of blood conservation in patients with preexisting thromboembolic risk undergoing minimally invasive TKA. This trial is registered with Clinicaltrials.gov (NCT02865174) on 08/09/2016.
Collapse
|
4
|
Abstract
Severe hemorrhage causes significant metabolic and cellular dysfunction secondary to deficient tissue perfusion and oxygen delivery. If bleeding continues, hemodynamic destabilization, hypoxemia, multiple organ failure, and death will occur. Techniques employed to promote hemostasis include surgical suture ligatures, cautery, chemical agents, self-assembling nanoparticles, and physical methods, like mechanical pressure. Improved understanding of the natural clotting cascade has allowed newly designed agents to become more targeted for clinical and military use. Topically-applied hemostatic agents have enormous clinical applications in achieving hemostasis. This manuscript describes currently available and developing topical hemostatic materials, including topical active agents, mechanical agents, synthetic/hemisynthetic hemostatic agents, and external hemostatic dressings for clinical practice.
Collapse
|
5
|
Abstract
Uncontrolled surgical bleeding can have significant clinical and economic consequences including advanced medical expenses and impairment of the outcomes. Effective and safe local hemostatic agents based on a fluid active hemostatic matrix are reviewed in the article. The use of this agent is followed by reduced hospital-stay, number of redo interventions for bleeding, reduced time of surgery, intra- and postoperative complication rate and high economic efficiency.
Collapse
Affiliation(s)
- A B Zemlyanoy
- Pirogov National Medical and Surgical Center of Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
6
|
Wu Y, Wu Y, Gangoli G, Bourcet A, Danker W, Gong Q, Zhan H, Chen W, Wang Z. Using flowable gelatin in anterior cervical spine surgery in real-world practice: a retrospective cohort study. J Comp Eff Res 2019; 8:317-326. [PMID: 30681001 DOI: 10.2217/cer-2018-0121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIM To assess the clinical and economic impact of flowable gelatin hemostatic matrix (FGHM) in anterior cervical spine surgery (ACSS). PATIENTS & METHODS A total of 451 patients with performed ACSS were included to compare FGHM with conventional hemostatic methods for clinical and cost outcomes using propensity score matching method. RESULTS The comparisons of the matched 125 pairs observed that FGHM was associated with significantly lower blood transfusion volume (11.2 vs 36.3 ml; p = 0.039), shorter postsurgery hospital stay length (3.7 vs 4.7 days; p = 0.002), shorter operation time (103.5 vs 117.7 min; p = 0.004), lower drainage placement rate (51.2 vs 89.6%; p < 0.001) and also lower total hospital costs (median ¥64,717 vs ¥65,064; p = 0.035). CONCLUSION Use of FGHM in ACSS improved perioperative outcomes without increasing hospital costs.
Collapse
Affiliation(s)
- Yunchang Wu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Yiqing Wu
- Health Economics, Johnson & Johnson Medical China, Shanghai, China
| | - Gaurav Gangoli
- Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Somerville, NJ, USA
| | - Anh Bourcet
- Health Economics, Johnson & Johnson Medical Asia-Pacific, Singapore
| | - Walter Danker
- Health Economics & Market Access, Johnson & Johnson Medical Devices Companies, Somerville, NJ, USA
| | - Qianyi Gong
- Health Economics and Outcomes Research, Changsha Normin Health Technology Ltd, Changsha, Hunan, China
| | - Huan Zhan
- Health Economics and Outcomes Research, Changsha Normin Health Technology Ltd, Changsha, Hunan, China
| | - Wendong Chen
- Health Economics and Outcomes Research, Changsha Normin Health Technology Ltd, Changsha, Hunan, China.,Health Economics and Outcomes Research, Normin Health Consulting Ltd, Toronto, Ontario, Canada
| | - Zheng Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
7
|
Helito CP, Bonadio MB, Sobrado MF, Giglio PN, Pécora JR, Camanho GL, Demange MK. Comparison of Floseal® and Tranexamic Acid for Bleeding Control after Total Knee Arthroplasty: a Prospective Randomized Study. Clinics (Sao Paulo) 2019; 74:e1186. [PMID: 31778430 PMCID: PMC6844142 DOI: 10.6061/clinics/2019/e1186] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Tranexamic acid (TXA) and the hemostatic agent Floseal® have already been used to minimize bleeding during total knee arthroplasty (TKA). METHODS We conducted a prospective, randomized study of 90 patients with indications for TKA. Following inclusion, the participants were randomly allocated in blocks to the following 3 groups: control, Floseal® and TXA. Bleeding parameters, including decreases in hemoglobin (Hb), drain output, number of blood transfusions and complications, were assessed. ClinicalTrials.gov: NCT02152917. RESULTS The mean decrease in Hb was highest in the control group (4.81±1.09 g/dL), followed by the Floseal® (3.5±1.03 g/dL) and TXA (3.03±1.2 g/dL) groups. The Floseal® and TXA groups did not differ, and both performed better than the control group. The mean total drain output was 901.3±695.7 mL in the control group, 546.5±543.5 mL in the TXA group and 331.2±278.7 mL in the Floseal® group. Both TXA and Floseal® had significantly less output than the control group, and Floseal® had significantly less output than TXA. The number of blood transfusions was very small in all 3 groups. CONCLUSION The use of TXA or Floseal® was associated with less blood loss than that of the control group among patients undergoing primary TKA, as measured both directly (intraoperative bleeding + drainage) and on the basis of a decrease in Hb, without differences in the rate of complications. TXA and Floseal® showed similar decreases in Hb and total measured blood loss, but the drain output was smaller in the Floseal® group.
Collapse
Affiliation(s)
- Camilo Partezani Helito
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
| | - Marcelo Batista Bonadio
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marcel Faraco Sobrado
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
- *Corresponding author. E-mail:
| | - Pedro Nogueira Giglio
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - José Ricardo Pécora
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Gilberto Luis Camanho
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marco Kawamura Demange
- Departamento de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| |
Collapse
|
8
|
Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial. Knee Surg Sports Traumatol Arthrosc 2015; 23:3337-42. [PMID: 25011643 DOI: 10.1007/s00167-014-3153-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 06/19/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. METHODS This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. RESULTS Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. CONCLUSIONS This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. CLINICAL RELEVANCE A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. LEVEL OF EVIDENCE II.
Collapse
|
9
|
Velyvis JH. Gelatin matrix use reduces postoperative bleeding after total knee arthroplasty. Orthopedics 2015; 38:e118-23. [PMID: 25665116 DOI: 10.3928/01477447-20150204-59] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 04/28/2014] [Indexed: 02/03/2023]
Abstract
Bleeding after total knee arthroplasty can result in significant morbidity and increases the need for blood transfusion. The proper use of intraoperative adjunctive topical hemostatic agents can enhance hemostasis perioperatively, potentially reducing blood transfusions. In this prospective study, 157 consecutive patients undergoing primary total knee arthroplasty received FLOSEAL (FLOSEAL Hemostatic Matrix; Baxter Healthcare Corporation, Hayward, California), a gelatin thrombin hemostatic matrix, 5 mL (74 patients) or 10 mL (83 patients). All patients received warfarin as thromboprophylaxis starting the day after surgery. Data were extracted via hospital chart review from 100 consecutive patients who underwent total knee arthroplasty and immediately preceded the FLOSEAL groups and did not receive FLOSEAL (control group). Postoperative drainage was significantly lower in the FLOSEAL 5 mL (236.9 mL) and 10 mL (120.5 mL) groups compared with the control group (430.8 mL; P<.0001 for both). The FLOSEAL 10 mL group had significantly less drainage than the FLOSEAL 5 mL group (P<.0001). The predicted probability of transfusion in the FLOSEAL 5 mL group was not significantly different compared with the control group (6.0% vs 7.6%, P=.650). The predicted probability of transfusion was lower in the FLOSEAL 10 mL group compared with the control group (0.5% vs 5.5%; P=.004). Within the FLOSEAL 10 mL group, application of FLOSEAL either before or after tourniquet release had a similarly significant effect on drainage volume and predicted probability of blood transfusion. No differences in outcomes were observed by type of anesthesia used. No adverse events occurred related to FLOSEAL use.
Collapse
|
10
|
Use of a haemostatic matrix does not reduce blood loss in minimally invasive total knee arthroplasty. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:435-41. [PMID: 25761324 DOI: 10.2450/2015.0199-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/24/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood loss can increase morbidity and the risk of transfusion after total knee arthroplasty (TKA). This study evaluated the difference in blood loss between minimally invasive TKA performed with and without intra-articular use of a haemostatic matrix (Floseal®). MATERIALS AND METHODS We retrospectively compared matched pairs in two groups (76 patients in each group): one group received conventional haemostasis (with bovie electrocoagulation), the other group was treated with an intra-articular haemostatic matrix (HM) as an adjunct to electrocoagulation. The outcomes compared were haemoglobin (Hb) and haematocrit levels at days 2 and 4 after surgery as a surrogate for blood loss, transfusion rate, surgical time, preoperative and postoperative range of motion (ROM) at days 21 and 42 and length of stay (LOS) in hospital. RESULTS No differences were observed for Hb levels at day 2 or day 4 between men in the two groups. In women, however, the mean Hb at day 2 was 11.1 g/dL (SD 1.3) for TKA with HM and 12.0 g/dL (SD 0.9) for TKA without HM (p<0.001), while that at day 4 was 10.6 g/dL (SD 1.3) for TKA with HM and 11.4 g/dL (SD 1.2) for TKA without HM (p<0.001). The haematocrit was higher for TKA without HM at day 2 (p=0.001) and day 4 (p=0.008). The transfusion rate for TKA with HM was 2.6% and for TKA without HM 0% (p=0.497), while the mean surgical time was 93 minutes (SD 12) vs 87 minutes (SD 14), respectively (p=0.0055). There were no differences in preoperative or postoperative ROM at days 21 and 42 between the two groups. The LOS was longer for TKA with HM than for TKA without HM (4.5 days and 4 days, respectively, p=0.011) influenced by the longer stay for the transfused patients. DISCUSSION The present study showed that the use of Floseal had no effect on reducing either visible or hidden blood loss after TKA, as assessed by a drop in Hb or haematocrit and that hidden blood loss was more important in women treated with the HM.
Collapse
|
11
|
Echave M, Oyagüez I, Casado MA. Use of Floseal®, a human gelatine-thrombin matrix sealant, in surgery: a systematic review. BMC Surg 2014; 14:111. [PMID: 25528250 PMCID: PMC4289565 DOI: 10.1186/1471-2482-14-111] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 12/16/2014] [Indexed: 11/16/2022] Open
Abstract
Background Surgical bleeding can be associated with an increased risk of morbidity and mortality across all surgical areas. Thus, numerous products have been developed to achieve haemostasis. A flowable haemostatic matrix such as Floseal® can quickly and reliably stop bleeding across the full spectrum of bleeding scenarios. The aim of this study was to systematically review clinical and economic evidence regarding the use of Floseal® in surgical procedures. Methods An extensive literature search was conducted in PubMed, EMBASE, and the Cochrane Library over the period spanning 2003–2013 to identify publications related to Floseal® use in all types of surgical procedures. Case reports and case series studies were excluded. Results A total of 27 papers met the selection criteria and were analysed. In the studies, blood loss and the time to achieve haemostasis were the most reported outcomes used to assess the efficacy of Floseal®. The majority of published studies (64%) examined the use of Floseal® compared with conventional methods (such as electrocautery or suturing). The remaining 36% of the studies evaluated the use of Floseal® compared with other haemostatic agents, such as Surgicel®, Gelfoam®, and Hemostase®. FloSeal® has been demonstrated to be an efficacious method in surgical procedures to reduce the time to achieve haemostasis, the frequency of intra- and postoperative bleeding, and the length of hospital stay, among other primary outcomes, resulting in less consumption of health resources. Conclusions The majority of the selected studies confirmed that Floseal® showed improvements over other haemostatic agents in achieving haemostasis and reducing blood loss. Electronic supplementary material The online version of this article (doi:10.1186/1471-2482-14-111) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- María Echave
- Pharmacoeconomics & Outcomes Research Iberia, Pozuelo de Alarcón Madrid, Spain.
| | | | | |
Collapse
|
12
|
Wang C, Han Z, Zhang T, Ma JX, Jiang X, Wang Y, Ma XL. The efficacy of a thrombin-based hemostatic agent in primary total knee arthroplasty: a meta-analysis. J Orthop Surg Res 2014; 9:90. [PMID: 25316253 PMCID: PMC4212119 DOI: 10.1186/s13018-014-0090-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 09/22/2014] [Indexed: 11/10/2022] Open
Abstract
Purpose Total knee arthroplasty (TKA) is a popular procedure in severe osteoarthritis. But perioperative bleeding remains a problem. Floseal® is a mixture of thrombin and bovine gelatin which can benefit a lot on reducing intraoperative and postoperative bleeding. However, there is no enough evidence judging its safety and efficiency. So a meta-analysis is conducted by us to evaluate the efficacy and safety of a thrombin-based hemostatic agent compared with conventional methods in TKA. Method Two independent reviewers selected literatures published before August 2014 from MEDLINE, Embase, and The Cochrane Central Register of Controlled Trials. Other internet databases were also performed to identify trials according to the Cochrane Collaboration guidelines. High-quality randomized controlled trials (RCTs), prospective control trials (PCTs), and case controlled trials (CCTs) were selected. The meta-analysis was undertaken using RevMan 5.1 for Windows. Results Three RCTs, one PCT, and one CCT met the inclusion criteria. There were significant differences in hemoglobin decline and calculated total blood loss between the Floseal® group and control group. There were no significant differences in postoperative drainage volume, rate of transfusion requirement, incidence of wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE) between treatment and control groups. Conclusions The present meta-analysis indicates that a thrombin-based hemostatic agent can reduce hemoglobin decline and calculated total blood loss after TKA and is not related to adverse reactions or complications such as wound infection, DVT, and PE.
Collapse
Affiliation(s)
- Chen Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China. .,Tianjin Medical University, Tianjin, 300070, People's Republic of China.
| | - Zhe Han
- Department of Orthopedics, Tianjin Hospital, Tianjin, 300211, People's Republic of China.
| | - Tao Zhang
- General Hospital of Tianjin Medical University, Tianjin, 300052, People's Republic of China.
| | - Jian-xiong Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Xuan Jiang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Ying Wang
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| | - Xin-long Ma
- Biomechanics Labs of Orthopaedics Institute, Tianjin Hospital, Tianjin, 300050, People's Republic of China.
| |
Collapse
|
13
|
Saleh A, Hebeish M, Farias-Kovac M, Klika AK, Patel P, Suarez J, Barsoum WK. Use of Hemostatic Agents in Hip and Knee Arthroplasty: A Critical Analysis Review. JBJS Rev 2014; 2:01874474-201401000-00001. [PMID: 27490809 DOI: 10.2106/jbjs.rvw.m.00061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Anas Saleh
- Department of Orthopaedic Surgery, Cleveland Clinic, 9500 Euclid Avenue, A41, Cleveland, OH 44195
| | | | | | | | | | | | | |
Collapse
|
14
|
Helito CP, Gobbi RG, Castrillon LM, Hinkel BB, Pécora JR, Camanho GL. Comparison of Floseal(r) and electrocautery in hemostasis after total knee arthroplasty. ACTA ORTOPEDICA BRASILEIRA 2014; 21:320-2. [PMID: 24453689 PMCID: PMC3874987 DOI: 10.1590/s1413-78522013000600004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 07/06/2013] [Indexed: 11/22/2022]
Abstract
Objective To evaluate whether hemostasis with eletrocauterization in comparison with Floseal(r) leads to different bleeding rates during total knee arthroplasty. Methods A comparative study was performed between two groups: group with ten consecutive total knee arthroplasties with Floseal(r) used as hemostatic method and control group with ten consecutive total knee arthroplasties with eletrocauterization as hemostatic method. Bleeding parameters such as debit of the drain, liquid infusion and blood transfusion rate were recorded. Results Floseal(r) group received less blood transfusion, less liquid infusion and lower drainage in absolute numbers compared to the control group. However, no parameter was statistically significant. Conclusion Hemostasis with Floseal(r) is as effective as hemostasis with eletrocauterization, what makes it a viable alternative to patients with contraindication to electric scalpel use. Level of Evidence II, Prospective Comparative Study.
Collapse
|