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Impacto clínico e no tempo de internamento da introdução do protocolo de ácido tranexâmico intra-articular, na artroplastia total do joelho: a experiência de um Centro Hospitalar e Universitário
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RESUMO - Enquadramento: A artroplastia total do joelho, apesar de ser um tratamento eficaz no alívio da dor e melhoria funcional do membro inferior, promove perdas sanguíneas elevadas que favorecem o aumento do tempo de internamento, da necessidade transfusional, da morbidade e mortalidade. A utilização de ácido tranexâmico, neste procedimento, tem-se mostrado eficaz tanto na redução das perdas hemáticas como das transfusões sanguíneas, não havendo, contudo, um consenso na via de administração e na dosagem adequada.
Objetivo: O presente estudo tem, como propósito, avaliar o impacto da implementação do protocolo de administração única de 1 g ácido tranexâmico por via intra-articular na redução das perdas hemáticas, na necessidade transfusional, no tempo de internamento, e na ocorrência de eventos adversos em doentes submetidos a este procedimento.
Metodologia: Foi realizado um estudo observacional retrospetivo de coorte clínico. Foram criadas duas cortes, a primeira que compreendeu um total de 308 procedimentos realizados entre 01/01/2015 e 31/12/2016 (prévia à implementação do protocolo) e a segunda um total de 349 procedimentos realizados entre 01/01/2017 e 31/12/2018 (após a implementação do protocolo).
Resultados: Observou-se, sem aumento da ocorrência de eventos adversos, uma redução média em 260ml nas perdas hemáticas, em cerca de 39% nas necessidades transfusionais, e em um dia no tempo de internamento, no grupo que realizou o protocolo.
Conclusão: Este protocolo aporta benefícios para os doentes e para a redução de custos. A sua utilização permitiu uma melhoria na qualidade dos cuidados prestados, promovendo uma melhoria na efetividade e na eficiência deste procedimento.
ABSTRACT - Background: Although total knee arthroplasty provides an effective treatment for pain relief and functionality of the lower limb, it increases blood losses, which favours an increase in length of stay, transfusion needs, morbidity and mortality. The use of tranexamic acid in this procedure has been shown to be effective both in reducing blood losses and blood transfusions, although there is no consensus on the route of administration and the appropriate dosage. Objective: The present study aims to evaluate the impact of implementing the protocol of a single administration of 1 g tranexamic acid intra-articular, in the reduction of blood loss, transfusion requirements, length of stay, and in the occurrence of adverse events in patients submitted to this procedure. Methodology: A retrospective observational clinical cohort study was performed. Two cohorts were identified, the first with a total of 308 procedures performed between 01/01/2015 and 31/12/2016 (prior to the implementation of the protocol), and the second with a total of 349 procedures performed between 01/01/2017 and 31/12/2018 (after the implementation of the protocol). Results: There was an average reduction of 260ml in blood losses, 39% in transfusion needs and one day in the length of stay (in the group that performed the protocol) with no increase in the occurrence of adverse events. Conclusion: This protocol brings benefits to patients and to cost reduction, providing an increase in the quality of care offered, and promoting an improvement in the effectiveness and efficiency of this procedure.
ABSTRACT - Background: Although total knee arthroplasty provides an effective treatment for pain relief and functionality of the lower limb, it increases blood losses, which favours an increase in length of stay, transfusion needs, morbidity and mortality. The use of tranexamic acid in this procedure has been shown to be effective both in reducing blood losses and blood transfusions, although there is no consensus on the route of administration and the appropriate dosage. Objective: The present study aims to evaluate the impact of implementing the protocol of a single administration of 1 g tranexamic acid intra-articular, in the reduction of blood loss, transfusion requirements, length of stay, and in the occurrence of adverse events in patients submitted to this procedure. Methodology: A retrospective observational clinical cohort study was performed. Two cohorts were identified, the first with a total of 308 procedures performed between 01/01/2015 and 31/12/2016 (prior to the implementation of the protocol), and the second with a total of 349 procedures performed between 01/01/2017 and 31/12/2018 (after the implementation of the protocol). Results: There was an average reduction of 260ml in blood losses, 39% in transfusion needs and one day in the length of stay (in the group that performed the protocol) with no increase in the occurrence of adverse events. Conclusion: This protocol brings benefits to patients and to cost reduction, providing an increase in the quality of care offered, and promoting an improvement in the effectiveness and efficiency of this procedure.
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Impacto clínico Tempo de internamento Ácido tranexâmico intra-articular Artroplastia total do joelho Total knee arthroplasty Clinical impact Hospitalization Intra-articular tranexamic acid