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Researchers recommend against routine bovine thrombin use to reduce blood loss in TKA
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Bovine thrombin slightly reduced blood loss after total knee arthroplasty in this randomized clinical trial, but researchers noted it was not cost effective enough to warrant routine use.
[W]e would conclude based on our current study and review of the literature that insufficient evidence exists currently to support the routine use of such local intra-articular procoagulant treatments, whether they be mechanical (bipolar sealer) or pharmacological (autologous platelet gel, Thrombin JMI [Pfizer; New York]),” Sharat K. Kusuma, MD, and colleagues from Columbus, Ohio, wrote in the study. “Many of these treatments carry with them a significant expense that must be demonstrated as cost effective to warrant routine use.”
Kusuma and colleagues performed a double-blinded, randomized clinical trial of 80 patients undergoing total knee arthroplasty (TKA), according to the abstract. They gave half of the patients intra-articular bovine thrombin during wound closure, with the other half of patients acting as a control.
While bovine thrombin slightly reduced blood loss, the researchers found no significant differences regarding Knee Society scores, drain outputs, length of stay and transfusion rates in either group. Kusuma and colleagues also found the group with bovine thrombin had a slightly higher hemoglobin level, but this result was not statistically significant.
Disclosure: Kusuma is a paid consultant and receives research support from Zimmer, Smith & Nephew and is a paid consultant for Medtronic and Graftys. One of the authors (Wasielewski) receives royalties from DePuy and Zimmer and is a paid consultant for Zimmer.
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