Reinfusion Drains vs Tranexamic Acid in Total Joint Arthroplasty

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: NCT01636414
Recruitment Status : Completed
First Posted : July 10, 2012
Results First Posted : April 25, 2016
Last Update Posted : August 22, 2016
Information provided by (Responsible Party):
OrthoCarolina Research Institute, Inc.

Brief Summary:

It is widely reported that a large percentage of total joint replacement patients receive allogeneic (human donor blood) blood transfusions due to perioperative blood loss with numbers ranging from 30% to 80%.

The risks of allogenic blood transfusion are well documented in the literature. In addition, they are time-consuming: often lengthening hospital stay and decreasing the availability for postoperative physical therapy. Moreover, they are costly at several hundred dollars per unit, and allogeneic transfusions are linked with immunosuppression and increased postoperative infection rates and wound healing problems, which are devastating complications in this elective, joint replacement population. Several options are available for diminishing the need for allogenic blood transfusion following elective total joint replacement. These include the use of perioperative blood salvage devices (OrthoPAT) and tranexamic acid. While there is data to support the use of both OrthoPat and Tranexamic acid in primary total joint arthroplasty, there is little information comparing one versus the other in terms of efficacy and economics.

The purpose of this study is to compare the safety, effectiveness and cost benefit of Hemovac drain, OrthoPAT and Tranexamic Acid to manage blood loss during total hip and total knee replacement surgery.

Condition or disease Intervention/treatment Phase
Total Joint Arthroplasty Procedure: Hemovac drain Procedure: Re-infusion drain Procedure: Tranexamic drain Phase 4

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 204 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Study Start Date : May 2012
Actual Primary Completion Date : June 2014
Actual Study Completion Date : October 2015

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Active Comparator: Hemovac drain Procedure: Hemovac drain
The Hemovac drain is a device placed under your skin used to collect blood during surgery.

Active Comparator: Re-infusion drain Procedure: Re-infusion drain
This device is used during and after surgery to collect blood lost during this time and prepares the blood for possible reinfusion.

Active Comparator: Tranexamic drain Procedure: Tranexamic drain
Tranexamic Acid is a synthetic amino acid that prevents the breakdown of blood clots which reduces bleeding.

Primary Outcome Measures :
  1. Blood Transfusion [ Time Frame: Inpatient Postoperative, on average 3 days after surgery ]
    Transfusion Rate (i.e, number of participants needing Blood Transfusion) Between Treatment Groups

  2. Change in Hemoglobin Level [ Time Frame: Post-operative on day 2 (first day after surgery) ]
    Change in hemoglobin following surgery. Initial (baseline) measure was prior to surgery on day of surgery. Follow-up measurement occurred the day following surgery.

Information from the National Library of Medicine

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

Inclusion Criteria:

  1. Patients presenting for primary unilateral hip or knee arthroplasty
  2. > 18 years of age
  3. Preoperative hemoglobin on day of surgery > 10mg/dL

Exclusion Criteria:

  1. Patients with a preoperative Hgb < 10mg/dL
  2. Patients who are unwilling to consent to blood transfusions
  3. Patients with a history of bleeding disorder
  4. Patients on anticoagulation therapy preoperatively (ASA 325mg, Plavix or Coumadin)
  5. Patients with a history of Thromboembolic events ( DVT, PE, CVA MI)
  6. Patients with platelet counts < 100,000
  7. Patients with kidney disease (Serum Cr > 1.2)
  8. Patients with end stage renal disease or on hemodialysis
  9. Patients with renal transplant
  10. Patients presenting for bilateral total hip or knee arthroplasty
  11. Patients presenting for conversion or revision total hip or knee procedures
  12. Patients donating pre-autologous blood
  13. Patients with primary hematologic disease or malignancy
  14. Patients with allergy to Tranexamic Acid
  15. Patients with hepatic disease
  16. Patients not discontinuing steroid use prior to surgery
  17. Patients with religious beliefs/practices prohibiting blood transfusions
  18. Patients with cognitive impairment
  19. Patients who are terminally ill

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): NCT01636414

United States, North Carolina
OrthoCarolina, PA
Charlotte, North Carolina, United States, 28207
Sponsors and Collaborators
OrthoCarolina Research Institute, Inc.

Responsible Party: OrthoCarolina Research Institute, Inc. Identifier: NCT01636414     History of Changes
Obsolete Identifiers: NCT01514474
Other Study ID Numbers: 051114B
First Posted: July 10, 2012    Key Record Dates
Results First Posted: April 25, 2016
Last Update Posted: August 22, 2016
Last Verified: July 2016

Keywords provided by OrthoCarolina Research Institute, Inc.:
Total joint arthroplasty, blood loss

Additional relevant MeSH terms:
Tranexamic Acid
Antifibrinolytic Agents
Fibrin Modulating Agents
Molecular Mechanisms of Pharmacological Action