Fibrin Glue or Tranexamic Acid for Total Knee Arthroplasty (ATRHEMOS)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01306370
Recruitment Status : Completed
First Posted : March 1, 2011
Last Update Posted : August 28, 2013
Banc de Sang i Teixits
Information provided by (Responsible Party):
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau

Brief Summary:


a) Principal: To assess if the fibrin glue or the tranexamic acid reduce less than 20% the blood losses with respect to the habitual haemostasia in patients with arthroplasty total of knee.

Secondaries: To assess the treatment safety. To perform a cost- analyses.

Methods: Randomized, unicentric, and parallel clinical trial with four comparative groups: Tissucol® (fibrin glue), fibrin glue manufactured by the Cryoseal® system (Banc de Sang i Teixits de Catalunya), tranexamic acid and habitual haemostasia.

Nº of participant centres: 1. Random allocation will be centralised.

Main outcome: Blood losses (ml) in the post-operatory period collected by the habitual drain system.

Secondary outcomes: Proportion of patients with blood transfusion, complications of surgery wound, pre and post-operative haemoglobin, units of blood transfused, post-operative mortality, days of hospital stay, safety of interventions assessed.

Size sample calculation: The number needed of patients is 172 (43 per group) to demonstrate a 20% difference in the post-operative blood losses between the treatments assessed and the habitual haemostasia, with a statistical power of 80% and a 0.05 bilateral alpha, and a 20% of withdrawals.

Statistical analysis: The investigators will perform a comparison of outcomes through the "t" test, the Mann-Whitney test of chi square, depending of the evaluated outcomes, quantitative or ordinals or qualitative, respectively. The software used will be Statistical Package for the Social Sciences (SPSS) version 17.

Condition or disease Intervention/treatment Phase
Knee Arthropathy Drug: Tranexamic Acid Drug: Fibrin glue Biological: Fibrin glue Other: Habitual haemostasis Phase 3

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 172 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: Prevention of Postoperative Blood Loss: Randomised Unicentric Parallel Clinical Trial That Assess the Efficacy of Fibrin Glue and Tranexamic Acid in Surgical Patients With a Total Knee Arthroplasty.
Study Start Date : June 2010
Actual Primary Completion Date : October 2011
Actual Study Completion Date : November 2011

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: Tranexamic acid
Tranexamic acid is a synthetic derivative of the amino acid lysine. It inhibits fibrinolysis by blocking the lysine binding sites on plasminogen and facilitates the coagulation process.
Drug: Tranexamic Acid

Two dosage during the surgical intervention: the first dosage 15-30' before the leg ischemia and the second dosage at 60 -90' after the first dosage.

Each dosage: 2 ampoules of 500mg/5 mL/ampoule

Other Name: Amchafibrin
Experimental: Fibrin glue BSTC
It is homologous fibrin glue from a single blood donor.
Biological: Fibrin glue
Topical administration, before to close the surgical wound.
Experimental: Tissucol
It is fibrin glue commercialized from multiple donors.
Drug: Fibrin glue
Topical administration, before to close the surgical wound. Dosage: 2 mL.
Other Name: Tissucol
Habitual haemostasis
Electrocoagulation of blood vessels was performed during surgery in all patients (routine hemostasis)
Other: Habitual haemostasis
The surgical habitual haemostasis.

Primary Outcome Measures :
  1. Postoperative blood loss (mL) [ Time Frame: During the first 48h after the surgical intervention ]
    Blood loss (mL) by the surgical wound collected by drain systems.

Secondary Outcome Measures :
  1. Percentage of patients that need a postoperative blood transfusion [ Time Frame: During the first postoperative week ]
  2. Percentage of patients with surgical wound infection [ Time Frame: During the first postoperative month ]
  3. Percentage of patients with surgical wound dehiscence [ Time Frame: During the first postoperative month ]
  4. Percentage of patients with re-intervention by wound complications [ Time Frame: During the first postoperative month ]
  5. Incidence of deep venous thrombosis [ Time Frame: During the first postoperative week ]
  6. Pain of surgical wound [ Time Frame: During the first postoperative week ]
  7. Units of blood transfusion [ Time Frame: During the first postoperative week ]
  8. hospital length stay [ Time Frame: Days ]
  9. Mortality [ Time Frame: During the first postoperative month ]

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Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Total knee arthroplasty
  • The patient consent to participate

Exclusion Criteria:

  • Intolerance drugs to the study or to bovine protein (aprotinin)
  • Antecedent of thromboembolic disease
  • Patient with cardiac alterations of the rhythm
  • Patients with valvular cardiac prosthesis
  • Patients with pro-thrombotic alterations of coagulation
  • Treatment with anticonceptive drugs

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01306370

Hospital de la Santa Creu i Sant Pau
Barcelona, Catalunya, Spain, 08025
Sponsors and Collaborators
Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau
Banc de Sang i Teixits
Study Director: Martinez Zapata, Mª José Centro Cochrane Iberoamericano. Servicio de Epidemiología Clínica y Salud Pública. IIB Sant Pau
Principal Investigator: Aguilera Roig, Xavier Hospital de la Santa Creu i Sant Pau. IIB Sant Pau

Responsible Party: Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau Identifier: NCT01306370     History of Changes
Other Study ID Numbers: 2009-017804-95
TRA-81 ( Other Grant/Funding Number: Spanish Health Ministry and Social Policy )
First Posted: March 1, 2011    Key Record Dates
Last Update Posted: August 28, 2013
Last Verified: August 2013

Keywords provided by Fundació Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau:
primary knee arthroplasty
fibrin glue
tranexamic acid

Additional relevant MeSH terms:
Joint Diseases
Musculoskeletal Diseases
Tranexamic Acid
Fibrin Tissue Adhesive
Antifibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action