The efficacy of aggressive warming combined with tranexamic acid during total hip arthroplasty: a single-center retrospective study from southern China.

OBJECTIVE: The aim of the study was to evaluate the efficacy of aggressive warming combined with tranexamic acid (TXA) during total hip arthroplasty (THA). PATIENTS AND METHODS: A total of 832 patients who underwent THA from October 2013 to June 2019 were divided into three groups according to the order of admission. There were 210 patients from October 2013 to March 2015 in group A, 302 patients from April 2015 to April 2017 in group B, and 320 patients from May 2017 to June 2019 in group C. Group A was the control group and was not given any measures. Group B was administered intravenously with 15 mg/kg TXA before skin incision and 3 h later without aggressive warming. Group C was administered intravenously with 15 mg/kg TXA before skin incision and 3 h later with aggressive warming. We evaluated the differences in the intraoperative blood loss, changes in core body temperature of patients at different stages during the operation, postoperative drainage, hidden blood loss, transfusion rate, drop of hemoglobin (Hb) on postoperative day 1 (POD1), prothrombin time (PT) of POD1, average hospitalization day, and complications. RESULTS: There were statistically significant differences among the three groups during the intraoperative blood loss, intraoperative changes in core body temperature, postoperative drainage, hidden blood loss, blood transfusion rate, drop of Hb on POD1 and average hospital stay (p<0.05). There was no statistical difference in PT on POD1 and the incidence of complications (p>0.05). CONCLUSIONS: Aggressive warming combined with TXA can significantly reduce the blood loss and transfusion rate of THA, and accelerate the recovery. We also observed that it does not increase the postoperative complications.

[Feasibility and perioperative safety of the combined procedure of catheter ablation and watchman left atrial appendage closure].

Objective: We aimed to explore the feasibility and perioperative safety of performing catheter ablation and left atrial appendage closure (LAAC) in a single (one-stop) session in patients with atrial fibrillation (AF). Methods: This study is an observational study. Consecutive AF patients who underwent the combined procedure of catheter ablation and LAAC with Watchman device of Xinhua Hospital in Shanghai between March 2017 and May 2019 were prospectively enrolled. Baseline, intra-and peri-procedural parameters were evaluated. Results: A total of 358 AF patients (189 males, (69.0±8.0) years) underwent the one-stop procedure. The CHA2DS2-VASc score was 3.2±1.5 and HAS-BLED score was 2.4±1.1, respectively in this patient cohort. Pulmonary vein isolation was achieved in all patients, while additional linear ablation was applied in 180 (50.3%) patients, yielding immediate success rate of 99.7%. Successful Watchman implantation was achieved in all patients. The perioperative serious adverse event occurred in 14 cases (3.9%). including 6 pericardial effusions (1.7%), 1 stroke (0.3%) and 5 vascular complications (1.4%), yielding procedure-related complication rate of 3.4%. In addition, 2 (0.6%) new-onset heart failures occurred postoperatively. There was no major bleeding or death during the perioperative period. Conclusions: Combined catheter ablation and LAAC can be successfully and safely performed in AF patients with high stroke risk. Follow-up data are needed to evaluate the outcome of this one-stop procedure.