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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(02): 320-325
DOI: 10.1055/s-0042-1757958
Artigo Original
Joelho

Comparação da perda sanguínea com a utilização do ácido tranexâmico endovenoso e intra-articular versus intra-articular isolado em artroplastia primária de joelho[*]

Article in several languages: português | English
Elemar da Silva Resch 
1   Departamento de Ortopedia e Traumatologia, Hospital Universitário de Santa Maria, Santa Maria, RS, Brasil
,
Leandro Silvestro Lemos 
2   Departamento de Ortopedia e Traumatologia, Clínica Millenarium Multi Especialidades, Porto Alegre, RS, Brasil
,
José Salvador Pantoja dos Santos 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
João Fernando Argento Pozzi 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
,
Ewerton Renato Konkevicz 
3   Serviço P&K de Cirurgia do Joelho, Porto Alegre, RS, Brasil
› Author Affiliations Suporte Financeiro Não houve suporte financeiro de fontes públicas, comerciais, ou sem fins lucrativos.
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Resumo

Objetivo O objetivo desse trabalho é comparar a perda sanguínea durante a artroplastia primária de joelho, com a utilização do ácido tranexâmico endovenoso e intra-articular (EV + IA) versus intra-articular (IA) isolado.

Métodos Trata-se de um ensaio clínico randomizado, duplo cego. Pacientes com indicação de artroplastia total primária de joelho foram captados em clínica especializada, onde foram operados pelo mesmo cirurgião, utilizando sempre a mesma técnica cirúrgica. Trinta pacientes foram alocados no grupo ácido tranexâmico EV + IA e 30 pacientes, no grupo IA, conforme randomização. Foi comparada a perda sanguínea através dos níveis de hemoglobina, hematócrito, volume do dreno e estimativa da perda sanguínea (EBL) (cálculo de Gross e Nadler).

Resultados Após a coleta, foram analisados os dados de 40 pacientes, sendo 22 do grupo IA isolado e 18 do grupo EV + IA. Ocorreram 20 perdas por erro de coleta. Entre os grupos IA e EV + IA, não ocorreram diferenças significativas em 24 horas entre os níveis de hemoglobina (10,56 vs. 10,65 g/dL; F1,39 = 0,63, p = 0,429), eritrócito (3,63 vs. 3,73 milhões/mm3; F1,39 = 0,90, p = 0,346), hematócrito (32,14 vs. 32,60%; F1,39 = 1,39; p = 0,240), volume de dreno (197,0 vs. 173,6 mL; F1,39 = 3,38; p = 0,069) e estimativa de perda sanguínea (EBL) (1.002,5 vs. 980,1; F1,39 = 0,09; p = 0,770). O mesmo ocorreu nas comparações realizadas 48 horas pós-operatório. O tempo foi fator significativo para a mudança de todas as variáveis de desfecho. Porém, o tratamento não modificou o efeito do tempo nesses desfechos. Nenhum indivíduo apresentou qualquer evento tromboembólico durante o período do trabalho.

Conclusões O uso do ácido tranexâmico EV + IA não demonstrou vantagem em redução de perda sanguínea quando comparado ao uso de ácido tranexâmico IA isolado nas artroplastias primárias de joelho. Esta técnica demonstrou-se segura, visto que nenhum evento trombo-embólico ocorreu durante o desenvolvimento do trabalho.

Palavras-chave

artroplastia do joelho - ácido tranexâmico - perda sanguínea

* Trabalho realizado no Hospital Regina, Novo Hamburgo, RS, Brasil.




Publication History

Received: 29 December 2021

Accepted: 12 September 2022

Article published online:
25 May 2023

© 2023. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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