RESUMO

OBJECTIVE: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). METHODS: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. RESULTS: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. CONCLUSIONS: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

OBJETIVO: Avaliar e comparar a eficácia clinica do uso intra-articular do ácido épsilon aminocaproico (AEAC) versus o ácido tranexâmico (ATX) na prótese total do joelho. MÉTODOS: Estudo clínico prospectivo, centro-único, duplo-cego e randomizado. Sessenta pacientes com osteoartrose de joelho foram incluídos. Os participantes foram divididos em dois grupos de 30 pacientes. No grupo ATX, foi aplicado 1 g de ATX (0.05 g/ml) intra-articular e, no grupo AEAC, foram aplicados 4 g de AEAC (0.2 g/ml) intra-articular. Valores séricos da hemoglobina (Hb) e hemtatócrito (Ht) foram dosados no pré-operatório e com 24 e 48 horas após a cirurgia. A amplitude de movimento e a dor também foram avaliadas no exame clínico. O índice WOMAC foi utilizado para avaliar a função do joelho antes e após dois meses da cirurgia. RESULTADOS: Foram avaliados 56 (93.3%) pacientes até o segundo mês pós-operatório. Depois da cirurgia, não houve diferenças entre os grupos (p > 0.05) na queda do valor de Hb e Ht com 24 ou 48 horas. Com relação à avaliação da dor, WOMAC e ganho de flexão do joelho, não houve vantagem significativa para nenhum dos grupos até os 60 dias depois da cirurgia(p > 0.05). CONCLUSÃO: A queda do valor da Hb e do Ht durante as primeiras 48 horas pós-operatórias e o risco de transfusão foram similares com o uso intra-articular de 1 g de ATX e 4 g de AEAC na artroplastia total do joelho. Os possíveis benefícios com relação ao controle da dor, ganho de flexão e função foram similares entre as duas drogas. Nível de Evidência II, Ensaio-Clínico Prospectivo, Randomizado, Duplo Cego, Centro-Único.

RESUMO

ABSTRACT Objective: To examine and compare the clinical efficacy of intraarticular epsilon aminocaproic acid (EACA) and tranexamic acid (TXA) in total knee arthroplasty (TKA). Methods: This study was a prospective, single-center, double-blinded randomized controlled trial, including sixty patients with osteoarthritis of the knee divided into two groups of 30 patients. In the TXA group, 1 g of TXA (0.05 g/ml) was applied intraarticularly, and in the EACA group, 4 g of EACA (0.2 g/ml) was applied intraarticularly. Serum hemoglobin (Hgb) and hematocrit (Htb) were measured during the preoperatively and 24 and 48 hours postoperatively. The range of motion and pain were evaluated by clinical examination. To evaluate knee function before and 2 months after surgery, the Western Ontario and McMaster Universities Index (WOMAC) questionnaire was used. Results: In total, 56 (93.3%) patients were evaluated up to the second postoperative month. No significant difference between the groups (p > 0.05) was found in the decrease in Hgb or Htb at 24 or 48 hours. Regarding assessment of the pain, WOMAC score and gain in knee flexion, no significant advantages up to 60 days after surgery (p > 0.05) were found. Conclusions: The decrease in Hgb and Htb during the first 48 hours postoperatively and the risk of transfusion were similar with the intraarticular use of 1 g of TXA and 4 g of EACA in TKA. The possible benefits regarding knee pain, gain in flexion and function were also similar for the two drugs. Level of Evidence II, Randomized, Double-Blinded, Single-Centre, Prospective Clinical Trial.

RESUMO Objetivo: Avaliar e comparar a eficácia clinica do uso intra-articular do ácido épsilon aminocaproico (AEAC) versus o ácido tranexâmico (ATX) na prótese total do joelho. Métodos: Estudo clínico prospectivo, centro-único, duplo-cego e randomizado. Sessenta pacientes com osteoartrose de joelho foram incluídos. Os participantes foram divididos em dois grupos de 30 pacientes. No grupo ATX, foi aplicado 1 g de ATX (0.05 g/ml) intra-articular e, no grupo AEAC, foram aplicados 4 g de AEAC (0.2 g/ml) intra-articular. Valores séricos da hemoglobina (Hb) e hemtatócrito (Ht) foram dosados no pré-operatório e com 24 e 48 horas após a cirurgia. A amplitude de movimento e a dor também foram avaliadas no exame clínico. O índice WOMAC foi utilizado para avaliar a função do joelho antes e após dois meses da cirurgia. Resultados: Foram avaliados 56 (93.3%) pacientes até o segundo mês pós-operatório. Depois da cirurgia, não houve diferenças entre os grupos (p > 0.05) na queda do valor de Hb e Ht com 24 ou 48 horas. Com relação à avaliação da dor, WOMAC e ganho de flexão do joelho, não houve vantagem significativa para nenhum dos grupos até os 60 dias depois da cirurgia(p > 0.05). Conclusão: A queda do valor da Hb e do Ht durante as primeiras 48 horas pós-operatórias e o risco de transfusão foram similares com o uso intra-articular de 1 g de ATX e 4 g de AEAC na artroplastia total do joelho. Os possíveis benefícios com relação ao controle da dor, ganho de flexão e função foram similares entre as duas drogas. Nível de Evidência II, Ensaio-Clínico Prospectivo, Randomizado, Duplo Cego, Centro-Único.

RESUMO

Introducción: la enfermedad de Von Willebrand es el trastorno de la coagulación con mayor prevalencia de mujeres en edad fértil y, por lo tanto, es el trastorno genético de la hemostasia más frecuente en la práctica ginecológica y obstétrica. Objetivo: hacer una revisión de la enfermedad de Von Willebrand en pacientes de ginecología y obstetricia con especial énfasis en la fisiopatología, el diagnóstico y el tratamiento. Metodología: se realizó una búsqueda bibliográfica en las bases de datos electrónicas MEDLINE/Pubmed, Elsevier, Interscience, EBSCO, Scopus, SciELO de 1980 al 2009, Cochrane Pregnancy and Childbirth Group (septiembre 30 del 2009) y libros de texto impresos. Resultados: el diagnóstico se basa en una cuidadosa anamnesis y pruebas de laboratorio de detección y confirmatorias. La correcta identificación de los diferentes tipos y subtipos es importante desde el punto de vista terapéutico. El tratamiento requiere medicaciones específicas como la desmopresina, concentrados de factor VIII y terapias coadyuvantes. No existe evidencia para contraindicar la vía vaginal del parto, sin embargo, se debe individualizar cada caso en particular. Conclusión: las mujeres con trastornos de la coagulación presentan durante la menarquia, la gestación, el parto y el puerperio un riesgo mayor de sangrado lo que hace obligatoria una adecuada evaluación y un manejo multidisciplinario durante el embarazo.

Introduction: Von Willebrand disease (vWD) is a disorder of the coagulation, being more prevalent in fertile females and is thus the most frequently occurring genetic haemostasis disorder in obstetric and gynaecological practice. Objective: reviewing the literature concerning vWD in obstetric and gynaecology patients, placing special emphasis on the disease’s physiopathology, diagnosis and treatment. Methodology: a bibliographic search was made of MEDLINE electronic databases via pubmed, Elsevier, Interscience, EBSCO, Scopus and SciELO from 1980 to 2009. The Cochrane Pregnancy and Childbirth Group (September 30th 2009) and printed texts and books were also consulted. Results: diagnosis was based on careful anamnesis and detection and confirmatory laboratory tests. Correct identification of different types and subtypes is important from a therapeutic point of view. Treatment requires specific medication such as desmopressin, factor VIII concentrates and coadjuvant therapies. No evidence was found to contraindicate vaginal birth route; however, each particular case must be taken individually. Conclusion: females suffering from coagulation disorders present a greater risk of bleeding during menarche, pregnancy, giving birth and the puerperium. This means that suitable evaluation and multidisciplinary management must be mandatory during pregnancy.

Assuntos

RESUMO

Twenty nine adult mongrel dogs were distributed into 5 groups, all were submitted to dorsal laminectomy and acute trauma with 500GCF to the spinal cord segments L1 and L2 through the Allen's modified method. In the dogs of the control group and in those medicated with epsilon aminocaproic acid and by myelotomy, there was not significant improvement. Dogs of medicated group with methylprednisolone sodium succinate, four animals had normal voluntary motor function with absent or severe proprioceptive deficit. It was concluded that glucocorticoid resulted in the best treatment employed in this experiment.

Vinte e nove cães, sem raça definida, foram distribuídos em 5 grupos, todos submetidos a laminectomia dorsal e contusão por trauma agudo com 500GCF aos segmentos medulares de L1 e L2, através do método de Allen modificado. No grupo controle e nos grupos tratados com ácido épsilon-aminocapróico e através de mielotomia parcial longitudinal dorsal, não ocorreu melhora significativa. Dos 6 cães medicados com succinato sódico de metilprednisolona, 4 apresentaram funções motoras voluntárias normais com ausência ou deficiência severa da propriocepção, resultando no melhor tratamento empregado neste experimento.

RESUMO

Twenty nine adult mongrel dogs were distributed into 5 groups, all were submitted to dorsal laminectomy and acute trauma with 500GCF to the spinal cord segments L1 and L2 through the Allen's modified method. In the dogs of the control group and in those medicated with epsilon aminocaproic acid and by myelotomy, there was not significant improvement. Dogs of medicated group with methylprednisolone sodium succinate, four animals had normal voluntary motor function with absent or severe proprioceptive deficit. It was concluded that glucocorticoid resulted in the best treatment employed in this experiment.

Vinte e nove cães, sem raça definida, foram distribuídos em 5 grupos, todos submetidos a laminectomia dorsal e contusão por trauma agudo com 500GCF aos segmentos medulares de L1 e L2, através do método de Allen modificado. No grupo controle e nos grupos tratados com ácido épsilon-aminocapróico e através de mielotomia parcial longitudinal dorsal, não ocorreu melhora significativa. Dos 6 cães medicados com succinato sódico de metilprednisolona, 4 apresentaram funções motoras voluntárias normais com ausência ou deficiência severa da propriocepção, resultando no melhor tratamento empregado neste experimento.