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Limitations of Preoperative PFA-200 as a Predictor of Postoperative Blood Loss in Total Knee Arthroplasty: According to Use of Tranexamic Acid by You La Jeon, Woo-In Lee, So Young Kang, Myeong Hee Kim

Background: Recently, anti-fibrinolytic agents (tranexamic acid) have been used to reduce blood loss or and the need for transfusion. We evaluated the clinical utility of PFA-200 as a predictor of postoperative blood loss in a clinical setting, where hemostasis can be affected by variables such as existing comorbidities and medication use.
Methods: We analyzed retrospectively 243 TKA patients having PFA-200 results between March 2014 and May 2016. We collected the medication history of anti-thrombotic agents, closure time measured by PFA-200, postoperative drainage volume, and perioperative change of hemoglobin values. Parameters associated with postoperative blood loss were compared to the prolongation of closure time and medication use. The influence of variables on postoperative blood loss was analyzed.
Results: The closure times of PFA-200 were prolonged in 68 patients (295.8 ± 10.7) and were not prolonged in 175 patients (125.4 ± 35.8). The prolonged closure time did not affect any parameters associated with postoperative blood loss. A history of preoperative anti-platelet agents used was a factor that statistically significantly increased the amount of postoperative drainage and reduction of perioperative hemoglobin values. In addition, postoperative tranexamic acid treatment was the factor that decreased the postoperative hemoglobin levels (OR = 0.297 with p = 0.010) most.
Conclusions: The effectiveness of preoperative PFA-200 in assessments of postoperative bleeding risk is reduced with postoperative use of tranexamic acid.

DOI: 10.7754/Clin.Lab.2017.161218