***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose . To evaluate the effectiveness of autologous fibrin tissue adhesive ( auto-FTA ) in reducing blood loss during cementless total hip arthroplasty ( THA ) . Methods . From September 2000 to August 2001 , 100 patients who predonated 400 ml of autologous blood were r and omised to undergo either st and ard treatment with auto-FTA ( auto-FTA group ) or st and ard treatment alone ( control group ) . The volume of postoperative blood loss and the decrease in haemoglobin level were measured . All patients were followed up for 3 years to evaluate the rate of bone ingrowth and heterotopic ossification . Results . The mean postoperative blood loss was 580 ml ( st and ard deviation [ SD ] , 240 ml ) in the auto-FTA group and 810 ml ( SD , 341 ml ) in the control group ; the difference was significant ( 230 ml , p<0.001 ) . The decrease in haemoglobin concentration was 17 g/l ( SD , 11 g/l ) in the auto-FTA group and 22 g/l ( SD , 12 g/l ) in the control group . The difference was significant ( 5 g/l , p=0.03 ) . The percentage of total blood loss of > 1200 ml in any single patient was significantly lower in the auto-FTA group ( 4 % ) than in the control group ( 20 % ) [ p=0.01 ] . Conclusion . Auto-FTA is a safe and effective means of reducing perioperative blood loss in THA The ideal method of providing tranexamic acid ( TXA ) for decreasing hemoglobin drop after TKA is still controversial . In this clinical trial , 200 patients were r and omly allocated to four groups . In group 1,500 mg TXA was administered intravenously . In group 2 , the joint irrigated with 3 g of TXA in 100 cc of saline . In group 3 , 1.5 g of TXA was injected through the drain . Group 4 did not take TXA . Albeit all methods had a statistical effect on hemoglobin drop , drainage and number of transfused units when compared to controls , but intravenous injection of TXA seems to be much more effective in terms of reducing hemoglobin drop and transfused units ; and what 's more TXA injection by drain is more effective regarding to reducing postoperative drainage In surgical practice , hemostasis is used to minimize postoperative bleeding in total knee arthroplasty . We performed a prospect i ve r and omized study to determine the influence of tourniquet use and the timing of its release on amount of bleeding .  Eighty four patients ( 96 knees ) were scheduled for total knee arthroplasty and r and omly divided into three groups . Posterior cruciate retaining bicompartmental total knee prostheses  were used in all . In group I , no tourniquet was used . In group II , a tourniquet was used and was deflated for hemostasis once all components had been inserted . In group III , the tourniquet was deflated after wound closure and application of a compressive dressing .  Mean blood drainage , mean volume of blood transfusion , hemoglobin ( Hb ) and hematocrit ( Hct ) values and operative time were compared between the three groups . Mean blood drainage was 810 mL ( 300 - 1300 ) in groups I 720 mL ( 240 - 1200 ) in group II and 705 mL ( 250 - 1150 ) in group III ( p = 0.062 ) . The Hb and Hct values , tourniquet time ( for groups II and III ) and volume of blood transfusion were similar . The operative time was significantly longer for first group ( p = 0.012 ) . Using tourniquet and its intraoperative release with hemostasis , does not reduce blood loss in total knee arthroplasty , but using tourniquet reduces operation time significantly Purpose The surgical stress of total knee arthroplasty ( TKA ) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity , which contributes significantly to post-operative blood loss .  Tranexamic acid , an antifibrinolytic drug , is commonly used to control post-operative blood loss . The recommended mode of administration of tranexamic acid is either oral or intravenous . However , the mechanism of action of the tranexamic acid points towards the possible effectiveness it may have following local/intra-articular application . This prospect i ve , double-blinded , r and omized preliminary study evaluated the efficacy of intra-articular tranexamic acid in reducing TKA-associated post-operative blood loss . Methods Fifty consenting patients with osteoarthritis of the knee scheduled for primary unilateral cemented-TKA were r and omly allocated to one of the two groups : Tranexamic Acid ( TA ) group ( n = 25 , 500 mg/5 ml tranexamic acid ) and the control group ( n = 25 , 5 ml 0.9 % saline ) . The drug and control solution were administered intra-articularly through the drain tube immediately after the wound closure . Parameters related to blood loss ( drop in haemoglobin , haematocrit differential ) and the drain output [ volume ( ml ) ] were compared between the two groups . Results On a comparative basis , TA-group obtained significant reduction in the drain output [ 95 % CI : 360.41–539.59 , p < 0.001 ] at 48 h post-operatively . Even though the control group received sixfold more blood transfusion than TA-group , it showed a greater drop in haemoglobin and haematocrit ( p < 0.05 ) . Conclusions Local application of tranexamic acid seems to be effective in reducing post-TKA blood loss as well as blood transfusion requirements . Level of evidence Therapeutic study , Level II In recent years , the application of fibrin sealant has been shown to be efficacious in the management of intraoperative and postoperative hemostasis . We design ed a prospect i ve r and omized controlled clinical trial to assess the efficacy of two different dosages of fibrin sealant ( 5 and 10 ml ) in patients undergoing total knee arthroplasty , as compared with the untreated control group . A total of 90 patients entered the study , r and omly assigned to one of the three groups : treatment with 5 ml fibrin sealant ( 30 patients ) , with 10 ml fibrin sealant ( 30 patients ) or no treatment ( 30 patients ) . A statistically significant difference in the mean reduction of hemoglobin concentrations was found on the first postoperative day in the treated groups as compared with the controls : 5 ml fibrin sealant ( 2.6 mg/dl ) and 10 ml fibrin sealant ( 2.5 mg/dl ) vs. controls ( 3.7 mg/dl ) ( P = 0.024 ) . The mean number of blood transfusions was significantly lower in the treated groups : 5 ml ( 0.5 ) and 10 ml ( 0.3 ) of fibrin sealant vs. controls ( 1 ) ( P = 0.0019 ) . Functional recovery was also better in the treated groups : on the seventh day , the joint ROM ( range of motion ) was statistically superior in the 5 ml group ( 96.5 ° ) and 10 ml group ( 98.8 ° ) as compared with the controls ( 75.5 ° ) ( P < 0.0001 ) . This study supports the efficacy of administering fibrin sealant in the perioperative management of bleeding after total knee arthroplasty and shows that a 5 ml dosage yields a comparable outcome to the 10 ml dosage previously reported in the literature Purpose Several studies have investigated effectiveness of fibrin spray or bipolar sealer to control peri-operative bleeding and reduce the need for blood transfusion , but a direct comparison between the two methods has not been previously performed . We conducted a prospect i ve r and omised trial , with st and ard electrocautery as a control group . Methods In our investigation , 95 patients were r and omised to one of three parallel groups receiving ( 1 ) 10 mL of topical fibrin spray before closure , ( 2 ) haemostasis with radiofrequency energy using a bipolar sealer , and ( 3 ) st and ard electrocautery . All patients and staff apart from the surgeons were blinded until data analysis was complete . Peri-operative blood loss has been calculated using a formula described by Ward and Gross ( considering estimated patient blood volume , pre- and post-operative haemoglobin and haematocrit levels ) , with mention of eventual blood re-infusion or transfusion , at given intervals from surgery ( 6 , 24 , 48 , 72 hours ) . Results Mean blood loss was lower for both methods investigated , compared to the control group at every time interval considered , although differences were stronger for fibrin spray [ Quixil ] . Mean blood saving at the given intervals from surgery ( 6–24–48–72 hours ) was respectively 96 ml , 129 ml , 296 ml , and 121 ml for bipolar sealer [ Aquamantys ] and 235 ml , 368 ml , 642 ml , and 490 ml for fibrin spray . These results are statistically significant ( p = 0.05 ) for fibrin spray at every interval compared to control values , while a significance is detectable for bipolar sealer only at 48 hours after surgery . Conclusions The fibrin spray group had the best performance in terms of blood loss , significantly reduced in comparison with the control group and bipolar sealer group . Blood loss reduction for the bipolar sealer was remarkable only at 48 hours , compared with the control group . Blood loss reduction for fibrin spray was significant at every time interval considered . Differences between the two treatments investigated and the control group narrowed slightly at 72 hours , as an expression of spontaneous homeostasis . Notable is the fact that blood volume saved with fibrin spray at 24 and 48 hours is comparable to the volume of at least one blood unit . A cost-effectiveness analysis should be considered in term of expense , biological risks ( related to blood transfusion or human-derived products use ) and bleeding-related complications Background The antifibrinolytic tranexamic acid reduces surgical blood loss , but studies have not identified an optimal regimen . Questions / purpose sWe studied different dosages , timings , and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA . Methods We prospect ively studied five regimens ( four intravenous , one local ; 40 patients each ) with a control group ( no tranexamic acid ) . The four intravenous ( 10-mg/kg dose ) regimens included ( 1 ) intraoperative dose ( IO ) given before tourniquet deflation , ( 2 ) additional preoperative dose ( POIO ) , ( 3 ) additional postoperative dose ( IOPO ) , and ( 4 ) all three doses ( POIOPO ) . The fifth regimen was a single local application ( LA ) . Two independent parameters of drain loss and total blood loss , calculated by the hemoglobin balance method , were evaluated statistically . Results Both parameters were reduced in all five regimens as against the control . A significant reduction in drain loss was seen in the POIO , IOPO , and POIOPO groups whereas total blood loss was significantly reduced in the POIO , POIOPO , and LA groups . The POIOPO group had the least drain loss ( 303 mL ) and least total blood loss ( 688 mL ) . The IO group had the greatest drain loss and the IOPO group the greatest total blood loss . Conclusions Single-dose tranexamic acid did not give effective results . The two-dose regimen of POIO was the least amount necessary for effective results . When compared against the control , this regimen produced reduction of drain loss and total blood loss , whereas the IOPO regimen did not . The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss . Level of Evidence Level I , therapeutic study . See Guidelines for Authors for a complete description of levels of evidence Background Total knee arthroplasty is associated with a significant postoperative blood loss even without any form of perioperative anticoagulation . Methods The potential role of QUIXIL ® , a fibrin sealant used in orthopaedic surgery to control blood loss and avoid blood transfusions in patients undergoing total knee arthroplasty was evaluated in a prospect i ve r and omized trial with twenty-four patients diagnosed with primary osteoarthritis of the knee . Results Results showed that application of 2 ml QUIXIL ®  adds costs to treatment without reducing the number of transfused red blood cell counts and postoperative haemoglobin loss . However , significant lower levels of postoperative fluid loss ( P = 0.026 ) was detected in QUIXIL ® treated patients . Conclusion Regarding cost effectiveness and benefit no indication for the use of 2 ml QUIXIL ® fibrin sealant in st and ard knee arthroplasty could be proofed statistically Tranexamic acid ( TEA ) , an inhibitor of fibrinolysis , reduces blood loss after routine total knee replacement ( TKR ) . However , controversy persists regarding the dosage and timing of administration of this drug during surgery . We performed a prospect i ve r and omised controlled study to examine the optimum blood-saving effect of TEA in minimally invasive TKR . We r and omly assigned 151 patients who underw 
    Output:
    
Tranexamic acid administered either orally , topically , intravenously or in combination decreased blood loss , increased the post-operative haemoglobin level , decreased the number of patients receiving blood transfusions and minimised the length of stay .
A similar result was found for fibrin spray in total hip arthroplasty .
However , for total knee arthroplasty , the outcome was blurred .
Tourniquet use was uniformly not significant in the measured parameters .
Tranexamic acid is useful in managing anaemia and blood loss .
Fibrin sealant also has this potential , but is not more potent than tranexamic acid .
Tourniquet use is not advantageous