Anales de la RANM

75 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 POSTOPERATIVE BLOOD SALVAGE AFTER KNEE ARTHROPLASTY Valbuena I, et al. An RANM. 2022;139(01): 67 - 77 Evaluation) (30,31). The latter did not support keeping preoperative APT in non-cardiac surgeries (32). Gombotz et al. (22) found also in TKR, THR and coronary by-pass, an increase in ABT with simple and double APT (43.8% and 62.6% respectively) at a similar rate to our results. Only found two retros- pective studies described an increase in bleeding and/ or ABT with no association with preoperative APT (33,34). Our study confirm these results. We could not identify anticoagulation as a ABT risk factor despite other studies having shown it to be so (35). Likewise, ASA Classification status > 3 was identified as a risk factor for complications during TKA recovery like anaemia and ABT. Similarly, preoperative anaemia is one of the most important and most studied transfusion risk factors, patients with Hb < 11 g/dl being those who would benefit most from preoperative hemoglobin optimization and blood-saving techniques like postoperative blood salvage (9, 27). Surgery time has been widely identified in the literature as another bleeding and ABT risk factor. Therefore, reducing surgery time as much as possible improves productivity and reduces bleeding and ABT (10, 36, 37, 38). Equally, it has also been shown that ABT increases LOS and PACU time significantly with much lower Hb during the stay (11, 22). In view of these results, the use of postoperative BS in TKA remains a good technique to reduce the need for ABT, minimizing the associated morbidity and mortality on this kind of surgery. Changes of practice in the last years have permitted to enter in the era of tranexamic acid, which has demonstrated its effecti- veness. Nevertheless, there is a lack of evidence about its safety and the incidence of severe adverse events in high risk patients. In most randomized clinical trials, patients with thromboembolic diseases were excluded (39, 40). Fillingham et al. published a meta-analysis in 2018 and didn’t either encounter any data concer- ning the incidence of arterial thrombosis (39). So, the published results on safety of tranexamic acid cannot be applied to patients with high risk of deep vein thrombosis and pulmonary embolism. However, high risk patients with an ASA > 3 classification status didn’t present a higher risk of developing vein thromboembolism in TKA, according to Fillingham meta-analysis (39). TABLE 4.- Allogenic blood transfusion decrease with the use of postoperative BS in current literature. Author, year ABT withuot BS vs. BS used ABT decrease p Thomas et al., 2001 20 28% vs. 7% 21 % < 0,001 Abuzakuk et al., 2007 14 23% vs. 25% Incremento de un 2% No significativo Moneen et al., 2007 10 16% vs. 2% 14 % 0,04 Muñoz et al., 2008 11 30% vs. 9% 21 % 0,001 Sinclair KC et al., 2009 41 52% vs. 25% 27 % 0,007 Park et al., 2012 40 26,7% vs. 0% 26,7 % < 0,05 Fraga et al., 2013 21 42,19% vs. 20,18% 22 % 0,0017 Muñoz et al., 2013 11 24,5% vs. 8,5% 16 % < 0,001 C ip et al., 2013 13 33% vs. 33% 0 % 0,999 Thomassen et al., 2014 15 7,3 % vs. 6,3% 1 % 0,857 So-Osman et al., 2014* 12 8,3% vs. 7,7% 0,6 % 0,19 Leigheb et al., 2016 2 34% vs. 10% 24 % < 0,001 Valbuena 33,1% vs. 20% 13,1 % 0,024 * This study only included patients with > 13 g/dl Hb levels. p: statistic signification; ABT: allogenic blood transfusion; BS: blood salvage.