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Baruah RK, Borah PJ, Haque R. Use of tranexamic acid in dynamic hip screw plate fixation for trochanteric fractures. J Orthop Surg (Hong Kong) 2016; 24:379-382. [PMID: 28031511 DOI: 10.1177/1602400322] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To evaluate perioperative blood loss and blood transfusion requirement in patients who underwent dynamic hip screw plate fixation for a stable trochanteric fracture with or without preoperative intravenous tranexamic acid (TXA). METHODS 49 men and 11 women (mean age, 56.5 years) who underwent open reduction and internal fixation with a dynamic hip screw plate for a stable trochanteric fracture by a single surgeon were equally randomised to receive either a single dose of intravenous TXA (15 mg/kg) 15 minutes prior to surgery or an equal volume of normal saline by slow infusion. Intra- and post-operative blood loss and the need for blood transfusion were assessed, as was any thromboembolic adverse event. RESULTS The TXA and control groups were comparable in terms of age, gender, body mass index, blood pressure, pulse rate, time from injury to surgery, operating time, and preoperative haematological data. Blood loss was lower in the TXA than control group intraoperatively (320.3 vs. 403.33 ml, p<0.001), during 0 to 24 hours (61.67 vs. 186.67 ml, p<0.001), and during 24 to 48 hours (27 vs. 86.67 ml, p<0.001), as well as the total volume (408.97 vs. 676.67 ml, p<0.001). Respectively for the TXA and control groups, 27 and 30 required 28 and 41 units of blood intra-operatively (p<0.001), and 6 and 15 required 6 and 15 units of blood postoperatively (p=0.014). No patient had any thromboembolic adverse event. CONCLUSION TXA is safe and effective in reducing blood loss in dynamic hip screw plate fixation for stable trochanteric fractures.
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Affiliation(s)
- Ranjit Kumar Baruah
- Department of Orthopaedics, Assam Medical College, Barbari, Dibrugarh, Assam, India
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Wu YG, Zeng Y, Yang TM, Si HB, Cao F, Shen B. The Efficacy and Safety of Combination of Intravenous and Topical Tranexamic Acid in Revision Hip Arthroplasty: A Randomized, Controlled Trial. J Arthroplasty 2016; 31:2548-2553. [PMID: 27179770 DOI: 10.1016/j.arth.2016.03.059] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/23/2016] [Accepted: 03/30/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Revision total hip arthroplasty (THA) is associated with substantial blood loss and a high probability of blood transfusion in the perioperative period. This study aimed to evaluate the efficacy and safety of combination of intravenous (IV) and topical tranexamic acid (TXA) in revision THA. METHODS Eighty-four consecutive patients undergoing revision THA were randomized into combined group and IV-TXA group. Patients in the combined group were given intravenously 15 mg/kg TXA as a preoperative, and topical TXA solution was applied at a concentration of 3 g TXA per 100-mL saline during the different procedure points. Patients in the IV-TXA group were given intravenously 15 mg/kg TXA alone. RESULTS The mean total blood loss, drainage volume, and maximum hemoglobin drop were significantly lower in the combined group than the IV-TXA group (P < .001, P < .001, P < .001, respectively). Compared with the IV-TXA group, the amount of blood transfusions and number of blood transfusions required were decreased dramatically in the combined group (P = .027, P < .001, respectively). One deep vein thrombosis and 4 calf muscular vein thrombosis in the combined group and 3 calf muscular vein thrombosis in the IV-TXA were detected by the Doppler ultrasound. No pulmonary embolism was observed and no significant differences were found in other complications between the 2 groups. CONCLUSION This study showed that combined administration of IV and topical TXA in revision THA can effectively decrease total blood loss and number of blood transfusions required without increasing the risk of deep vein thrombosis or/and pulmonary embolism compared with IV-TXA alone.
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Affiliation(s)
- Yuan-Gang Wu
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Yi Zeng
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Ti-Min Yang
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Hai-Bo Si
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Cao
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China
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Bellam BL, Dhibar DP, Suri V, Sharma N, Varma SC, Malhotra S, Bhalla A. Efficacy of tranexamic acid in haemoptysis: A randomized, controlled pilot study. Pulm Pharmacol Ther 2016; 40:80-3. [DOI: 10.1016/j.pupt.2016.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 06/22/2016] [Accepted: 07/22/2016] [Indexed: 12/11/2022]
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Fillingham YA, Kayupov E, Plummer DR, Moric M, Gerlinger TL, Della Valle CJ. The James A. Rand Young Investigator's Award: A Randomized Controlled Trial of Oral and Intravenous Tranexamic Acid in Total Knee Arthroplasty: The Same Efficacy at Lower Cost? J Arthroplasty 2016; 31:26-30. [PMID: 27113948 DOI: 10.1016/j.arth.2016.02.081] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/11/2016] [Accepted: 02/16/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) is a synthetic antifibrinolytic agent successfully used intravenously (IV) to reduce blood loss after total knee arthroplasty (TKA). An oral formulation of the medication is available, at a fraction of the cost of the IV preparation. The purpose of this randomized controlled trial is to determine if oral TXA is equivalent to IV TXA in reducing blood loss in TKA. METHODS In this double-blinded, placebo-controlled trial, patients undergoing primary TKA were randomized to receive 1.95g of TXA orally 2 hours preoperatively or 1g IV bolus before wound closure. The primary outcome was reduction of hemoglobin. Power analysis determined that 30 patients were required in each group. Equivalence analysis was performed with pooled and Satterthwaite t tests with a P-value of <.05 suggesting equivalence between treatments. RESULTS Thirty-four patients received oral TXA and 37 patients received IV TXA. There was no difference in the mean reduction of hemoglobin between oral and IV groups (3.45g/dL vs 3.31g/dL, respectively; P = .001, equivalence), and total blood loss was equivalent at 1281 mL vs 1231 mL, respectively (P = .02, equivalence). One patient in each group was transfused. CONCLUSION Oral TXA provides equivalent reductions in blood loss, at a cost of $14 compared with $47-$108 depending on the IV formulation selected. As approximately 700,000 primary TKA are performed in the United States annually, a switch to oral TXA could yield total cost savings of between $23 million and $67 million dollars per year for our health care system.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Erdan Kayupov
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Darren R Plummer
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Mario Moric
- Department of Anesthesia, Rush University Medical Center, Chicago, Illinois
| | - Tad L Gerlinger
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Abstract
Perioperative bleeding in cardiac surgery is related to both surgical trauma of blood vessels and defects in the hemostatic mechanism caused, in part, by cardiopulmonary bypass. Blood transfusion therefore remains a significant risk of cardiac surgery with important health and economic consequences. Blood conservation strategies for cardiac surgery have advanced over the years and the following discussion will focus on the current practices at Toronto General Hospital.
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Affiliation(s)
- Jacek M. Karski
- Department of Anaesthesia of the Toronto General Hospital of University of Toronto, Ontario, Canada
| | - Joselito T. Balatbat
- Department of Anesthesiology of University of Louisville Hospital, Louisville, Kentucky
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Abstract
OBJECTIVE To evaluate the net clinical benefit of tranexamic acid use in patients undergoing total knee or total hip replacement. METHODS This is a retrospective study of patients undergoing total knee or total hip replacement. The primary outcome was the net clinical benefit of tranexamic acid use. Secondary outcomes included length of stay, incidence of venous thromboembolism, change in hemoglobin, and number of units of blood transfused. RESULTS Four hundred and six patients were screened for inclusion and 327 patients met inclusion criteria; 174 patients received tranexamic acid versus 153 patients who received usual care. Tranexamic acid demonstrated a positive net clinical benefit versus usual care (40.8% vs 13.7%, P < .01) but did not affect length of stay (3.39 vs 3.37 days, respectively, P = .76). Venous thromboembolism was comparable between groups (2.3% vs 0.7%, P = .38). Average change in hemoglobin and need for transfusion were lower in the treatment group versus the usual care group, respectively (3.46 vs 4.26 mg/dL, P < .01). CONCLUSION Tranexamic acid demonstrated a significant benefit in decreasing change in hemoglobin as well as the need for blood transfusion with no increase in the risk of venous thromboembolism in patients undergoing total knee or total hip replacement.
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Affiliation(s)
| | - Mate M Soric
- 1 Northeast Ohio Medical University, Rootstown, OH, USA.,2 Internal Medicine, University Hospitals Geauga Medical Center, Chardon, OH, USA
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Zekcer A, Del Priori R, Tieppo C, da Silva RS, Severino NR. Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial. J Vasc Bras 2016; 15:120-125. [PMID: 29930576 PMCID: PMC5829705 DOI: 10.1590/1677-5449.007515] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Tranexamic acid (TXA) is widely used in orthopedic surgery to reduce perioperative bleeding. Since TXA inhibits fibrinolysis, there is concern that it may increase the risk of thromboembolic events. Objectives To verify the prevalence of deep venous thrombosis (DVT) in patients receiving TXA during total knee arthroplasty and to compare topical with intravenous administration of the drug. Methods All patients admitted for total knee arthroplasty due to primary arthrosis between June and November of 2014 were recruited consecutively. Thirty patients were randomized to a “topical group” (1.5 g TXA diluted in 50ml saline sprayed over the area operated, before tourniquet release), 30 to an “intravenous group” (20mg/kg TXA in 100 ml of saline, given at the same time as anesthesia), and 30 to a control group (100 ml of saline, given at the same time as anesthesia). All patients had duplex ultrasound scans of the legs on the 15th postoperative day. Results Deep venous thrombosis events occurred in five of the 90 patients operated (one out of 30 in the topical group [3.3%], four out of 30 in the control group [13.3%], and zero in the intravenous group). All were confirmed by duplex ultrasound scans and all were asymptomatic. Prevalence rates of DVT were similar between groups (p = 0.112 for control vs. intravenous; p = 0.353 for control vs. topical; and p =1.000 for intravenous vs. topical, according to two-sided exact tests). Conclusions Both topical and intravenous administration of TXA are safe with regard to occurrence of DVT, since the number of DVT cases in patients given TXA was not different to the number in those given placebo.
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Affiliation(s)
- Ari Zekcer
- Clínica Ortopédica Tatuapé, São Paulo, SP, Brazil
| | | | - Clauber Tieppo
- Instituto de Ortopedia Campo Belo, São Paulo, SP, Brazil
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Uso do ácido tranexâmico em artroplastia total primária de joelho: repercussões na perda sanguínea perioperatória. Braz J Anesthesiol 2016; 66:254-8. [DOI: 10.1016/j.bjan.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/04/2014] [Indexed: 11/22/2022] Open
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Volquind D, Zardo RA, Winkler BC, Londero BB, Zanelatto N, Leichtweis GP. Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss. Braz J Anesthesiol 2016; 66:254-8. [PMID: 27108821 DOI: 10.1016/j.bjane.2014.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/04/2014] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of tranexamic acid in primary total knee replacement surgeries has been the subject of constant study. The strategies to reduce bleeding are aimed at reducing the need for blood transfusion due to the risks involved. In this study we evaluated the use of tranexamic acid in reducing bleeding, need for blood transfusion, and prevalence of postoperative deep vein thrombosis in primary total knee replacement. METHOD 62 patients undergoing primary total knee replacement were enrolled in the study, from June 2012 to May 2013, and randomized to receive a single dose of 2.5g of intravenous tranexamic acid (Group TA) or saline (Group GP), 5min before opening the pneumatic tourniquet, respectively. Hemoglobin, hematocrit, and blood loss were recorded 24h after surgery. Deep vein thrombosis was investigated during patient's hospitalization and 15 and 30 days after surgery in review visits. RESULTS There was no demographic difference between groups. Group TA had 13.89% decreased hematocrit (p=0.925) compared to placebo. Group TA had a decrease of 12.28% (p=0.898) in hemoglobin compared to Group GP. Group TA had a mean decrease of 187.35mL in blood loss (25.32%) compared to group GP (p=0.027). The number of blood transfusions was higher in Group GP (p=0.078). Thromboembolic events were not seen in this study. CONCLUSION Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.
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Affiliation(s)
- Daniel Volquind
- Unidade de Ensino Médico Propedêutica Anestésico Cirúrgica da Universidade de Caxias do Sul, Caxias do Sul, RS, Brazil; Sociedade Brasileira de Anestesiologia (SBA), Rio de Janeiro, RJ, Brazil; Clínica de Anestesiologia de Caxias do Sul (CAN), Caxias do Sul, RS, Brazil.
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Jain NP, Nisthane PP, Shah NA. Combined Administration of Systemic and Topical Tranexamic Acid for Total Knee Arthroplasty: Can It Be a Better Regimen and Yet Safe? A Randomized Controlled Trial. J Arthroplasty 2016; 31:542-7. [PMID: 26507526 DOI: 10.1016/j.arth.2015.09.029] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/19/2015] [Accepted: 09/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is associated with substantial blood loss in postoperative period. Tranexamic acid (TXA) is potent antifibrinolytic agent, routinely administered by intravenous (IV) and topical route, which can possibly interrupt cascade of events due to hemostatic irregularities close to source of bleeding. However, scientific evidence of combined administration of TXA in TKA is still meagre. The present study aimed to compare efficacy of combined IV and topical TXA with IV use alone in terms of blood loss, transfusion rate, and incidence of deep vein thrombosis and thromboembolism. PATIENTS AND METHODS 119 patients undergoing unilateral TKA were randomized into IV alone and combined group. Patients assigned to IV group were given IV TXA as a preoperative and postoperative dose given 3 and 6 hours after surgery, whereas in combined group, topical TXA solution was applied intraarticularly about 5 minutes before closure of arthrotomy in addition to IV doses. RESULTS Combined use of IV and topical TXA provided better results than IV use alone with mean calculated total blood loss (590.69±191.1 vs 385.68±182.5, P<.001), blood transfusion rate (6.6% vs 1.6%, P = .364), hemoglobin drop (1.82±0.6 vs 1.14±0.5, P<.001). No case of DVT or TE was noted among the 2 study groups. CONCLUSION Combined use of IV and intraarticular TXA provided significantly better results compared with IV use alone with respect to all variables related to postoperative blood loss in TKA. Moreover, TXA use is safe in terms of incidence of symptomatic DVT and TE.
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Affiliation(s)
- Nimesh P Jain
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India
| | | | - Nilen A Shah
- Bombay Hospital and Research Centre, Marine Lines, Mumbai, Maharashtra, India
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Kaya S, Aksoy F, Kenç NN, Eroğlu A, Köksal İ. The Importance of Supportive Care with Tranexamic Acid in Crimean-Congo Hemorrhagic Fever. Chemotherapy 2016; 61:148-51. [PMID: 26784703 DOI: 10.1159/000442083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/02/2015] [Indexed: 02/05/2023]
Abstract
This report describes a case of Crimean-Congo hemorrhagic fever with widespread hemorrhages and multiple organ dysfunction syndrome in a 46-year-old patient from an endemic region. Although the patient had numerous poor prognostic factors, he was discharged in a healthy condition after 17 days of hospitalization with close monitoring and supportive care. Tranexamic acid was successfully used together with other supportive treatments.
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Chakravartty S, Sarma DR, Chang A, Patel AG. Staple Line Bleeding in Sleeve Gastrectomy—a Simple and Cost-Effective Solution. Obes Surg 2015; 26:1422-8. [DOI: 10.1007/s11695-015-1986-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Low Dose Perioperative Intravenous Tranexamic Acid in Patients Undergoing Total Knee Arthroplasty: A Double-Blind Randomized Placebo Controlled Clinical Trial. JOURNAL OF BLOOD TRANSFUSION 2015; 2015:948304. [PMID: 26770871 PMCID: PMC4684898 DOI: 10.1155/2015/948304] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/22/2015] [Accepted: 10/26/2015] [Indexed: 01/07/2023]
Abstract
Background and Objectives. The null hypothesis of this study was that TA has no effect on postsurgical bleeding in patients undergoing TKA. Methods. This study was a double-blind randomized trial. In the first group (T) patients received 500 mg of intravenous Tranexamic acid (TA) twice (once preoperatively and once 3 hours postoperatively) and in the second group (P) they received slow infusion of normal saline as placebo. The primary outcome of the study was the level of Hb 48 hours after surgery. Results. Hb levels 48 hours after surgery as the primary outcome were 10.92 ± 0.97 and 10.23 ± 0.98 (g/dL) in groups T and P, respectively, and the difference was statistically significant (P = 0.001). Statistically significant differences were also observed in Hb levels 6 and 24 hours after surgery, the drain output 48 hours after surgery, and the number of units of packed cells transfused between study groups (P < 0.05). There was no significant difference in duration of hospitalization between the study groups (P = n.s.). Conclusions. The low dose perioperative intravenous TA significantly reduces blood loss, requirement for blood transfusion, and drain output in patients undergoing TKA. However, duration of hospitalization did not change significantly.
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Yu X, Li W, Xu P, Liu J, Qiu Y, Zhu Y. Safety and Efficacy of Tranexamic Acid in Total Knee Arthroplasty. Med Sci Monit 2015; 21:3095-103. [PMID: 26463641 PMCID: PMC4610683 DOI: 10.12659/msm.895801] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of total knee arthroplasty (TKA) is increasing, which is one of the most frequent operations in orthopedic practice. To further investigate the safe and effective role of using tranexamic acid (TA) in reducing transfusion rate and blood loss in total knee arthroplasty. Material/Methods This meta-analysis was conducted according to the Cochrane methodology. Twenty-eight superior quality and well designed randomized controlled trials (RCT) were collected to analyze for this study. Patients who had undergone primary unilateral TKA were chosen. The software, RevMan 5.2, was used to analyze collected data. Results Finally, 28 RCTs were collected to analyze for this study. Total blood loss was dramatically decreased via the application of TA, by a mean of 420 ml [95% CI: −514 to −327]. A significant reduction about blood transfusion rate was also found in patients who received TA. [RD: −0.26, 95%CI: −0.33 to −0.19]. Moreover, no significant differences were found between TA and control groups in incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE). Conclusions This meta-analysis demonstrates that the application of TA in TKA could decrease total blood loss and transfusion rate. On the other hand, the application of TA is not associated with high incidence of DVT or other adverse events. TA should be taken into account in routine use in primary knee arthroplasty to benefit the patients.
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Affiliation(s)
- Xiao Yu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
| | - Weili Li
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
| | - Pengchen Xu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
| | - Jin Liu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
| | - Yue Qiu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
| | - Yuchang Zhu
- Department of Orthopaedics, Shanghai Tenth People's Hospital, Shanghai, China (mainland)
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Shinde A, Sobti A, Maniar S, Mishra A, Gite R, Shetty V. Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population. Asian J Transfus Sci 2015; 9:168-72. [PMID: 26420938 PMCID: PMC4562139 DOI: 10.4103/0973-6247.154251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction: For quite a few years, tranexamic acid (TEA) has been used during total knee arthroplasty (TKA) to reduce blood loss. However, no consensus exits regarding its timing and doses. Materials and Methods: We conducted a prospective, randomized double-blinded study of 56 patients in the Indian population undergoing TKA from 2011 to 2012. A dose of 10 mg/kg body weight of TEA (three doses) was given in one group and normal saline was administered in the other. Results: The mean blood loss in the TEA unilateral group was 295 mL ± 218 mL and in the placebo group was 482 mL ± 186 mL (P < 0.005). In the bilateral TEA group, the mean blood loss was 596 mL ± 235 mL and in the placebo group was 1349 mL ± 41 mL (P < 0.005). Conclusion: The number of patients requiring blood transfusion reduced substantially. There was no increase in the risk of deep vein thrombosis (DVT) and pulmonary embolism. TEA reduces intraoperative and postoperative blood loss and thus reduces the need of allogenic blood transfusion.
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Affiliation(s)
- Abhishek Shinde
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Anshul Sobti
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Shriji Maniar
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Amit Mishra
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Raju Gite
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Vivek Shetty
- Department of Orthopaedics, P.D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
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Digas G, Koutsogiannis I, Meletiadis G, Antonopoulou E, Karamoulas V, Bikos C. Intra-articular injection of tranexamic acid reduce blood loss in cemented total knee arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25:1181-8. [PMID: 26169991 DOI: 10.1007/s00590-015-1664-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/16/2015] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to compare the efficacy of intravenous and topical tranexamic acid (TXA) versus control group for reduction in blood loss following primary total knee arthroplasty (TKA). A total of 90 patients were prospectively allocated to each of three groups (control, intravenous IV and intra-articular) and underwent unilateral total knee arthroplasty. In the IV group, patients received one dose of TXA of 15 mg/kg before deflation of the tourniquet, while in the intra-articular group patients received 2 g TXA via the drain retrogradely after closure of the wound. The mean drained blood loss in control, IV and intra-articular groups was 415 ± 24, 192 ± 21 and 121 ± 17 ml, respectively. About 43 % (control), 23 % (IV) and 17 % (intra-articular) of each group required transfusion, and the mean transfusion was 338, 168 and 79 ml, respectively. Preoperative hemoglobin values decreased at 24 h by 2.80 ± 0.14, 2.24 ± 0.17 and 2.26 ± 0.18 mg/dl, respectively. TXA reduced blood loss and transfusion requirement. Compared with one-dose intravenous administration, intra-articular administration of TXA seems to be more effective in terms of reducing drained blood loss and transfusion frequency. We recommend administration of topical TXA in primary TKA in healthy patients to decrease perioperative blood loss.
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Affiliation(s)
- G Digas
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece.
| | - I Koutsogiannis
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece
| | - G Meletiadis
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece
| | - E Antonopoulou
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece
| | - V Karamoulas
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece
| | - Ch Bikos
- Orthopaedic department, General Hospital Xanthi, Xanthi, Greece
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Abstract
INTRODUCTION Posterior-stabilized (PS) and cruciate-retaining (CR) total knee arthroplasties (TKA) are both successfully used for treatment of end-stage osteoarthritis. The choice of constraint depends on knee deformity and stability as well as most importantly surgeon preference. The aim of this study was to compare the amount of blood loss and required transfusions following TKA with the two different designs. MATERIALS AND METHODS In a retrospective approach, 473 patients undergoing TKA were included (240 CR and 233 PS from a single manufacturer). Demographics at base line were comparable between both groups. Blood loss [red blood cell (RBC) loss] was calculated after documentation of pre- and postoperative hematocrit levels at discharge. Transfusion requirements were recorded. Statistical analysis was done using Mann-Whitney U test. RESULTS The calculated blood loss (RBC loss) at discharge was 548 ± 216 ml in the PS group compared with 502 ± 186 ml in the CR group (p = 0.032). There were no differences in the transfusion requirements between both groups (PS 0.41 vs. CR 0.37, p = 0.39). DISCUSSION The blood loss was significantly higher in the PS group. This may be due to the box preparation that exposes more cancellous femoral bone, which may add to postoperative bleeding. The differences remain, however, small, as they did not lead to a significantly higher transfusion rate with PS TKA.
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Lin SY, Chen CH, Fu YC, Huang PJ, Chang JK, Huang HT. The efficacy of combined use of intraarticular and intravenous tranexamic acid on reducing blood loss and transfusion rate in total knee arthroplasty. J Arthroplasty 2015; 30:776-80. [PMID: 25534864 DOI: 10.1016/j.arth.2014.12.001] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 10/31/2014] [Accepted: 12/02/2014] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study is to investigate the effect of preoperative intravenous (IV) and intraoperative topical administration of tranexamic acid (TXA) in total knee arthroplasty (TKA). A total of 120 patients were and randomly allocated to either topical group, combined group, or control group. The mean total blood loss was lower in the combined and topical groups (705 mL and 579 mL, respectively) in comparison with control group (949 mL, P < 0.001). There was a significant difference in transfusion rate among groups (P = 0.009). The postoperative hemoglobin drop and total drain amount were significantly less in the combined group compared to other groups. In conclusion, combining preoperative IV injection and topical administration of TXA can effectively reduce blood loss and transfusion rate.
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Affiliation(s)
- Sung-Yen Lin
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chung-Hwan Chen
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yin-Chih Fu
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peng-Ju Huang
- Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Je-Ken Chang
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsuan-Ti Huang
- Department of Orthopaedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Orthopaedics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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70
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Yue C, Pei F, Yang P, Xie J, Kang P. Effect of Topical Tranexamic Acid in Reducing Bleeding and Transfusions in TKA. Orthopedics 2015; 38:315-24. [PMID: 25970359 DOI: 10.3928/01477447-20150504-06] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/18/2015] [Indexed: 02/03/2023]
Abstract
Intravenous tranexamic acid (TXA) has been identified to be effective in total knee arthroplasty (TKA), but the effect of topical application is still unclear. Therefore, the authors conducted a meta-analysis to assess the effect of topical TXA in TKA. Twelve trials with a total of 1179 knees were included. The results revealed that the application of topical TXA in TKA significantly reduced total blood loss by a mean of 280.65 mL and reduced transfusions without increasing the risks of deep venous thrombosis and pulmonary embolism. Topical TXA also reduced postoperative drain output by a mean of 194.59 mL and lowered postoperative hemoglobin drop by a mean of 0.66 g/dL. In addition, subgroup analysis showed that high-concentration TXA may be better at reducing bleeding and transfusions than low-concentration TXA. Therefore, the authors concluded that topical TXA can effectively reduce bleeding and transfusion rate in TKA without increasing the risk of deep venous thrombosis and pulmonary embolism, and high-concentration (20 mg/mL or more) topical TXA is recommended.
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71
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Gupta K, Rastogi B, Krishan A, Gupta A, Singh VP, Agarwal S. The prophylactic role of tranexamic acid to reduce blood loss during radical surgery: A prospective study. Anesth Essays Res 2015; 6:70-3. [PMID: 25885506 PMCID: PMC4173437 DOI: 10.4103/0259-1162.103378] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The radical surgical procedures are associated with perioperative blood loss. This study was aimed to evaluate the clinical efficacy and safety of tranexamic acid in reducing perioperative blood loss in patients undergoing radical surgery. MATERIALS AND METHODS Sixty ASA class I and II adult consented female patients, scheduled for elective radical surgery and met the inclusion criterion, were blindly randomized into two groups to receive either intravenous 1 g tranexamic acid 20 min before skin incision or an equivalent volume of normal saline as placebo (P). All patient's total blood loss was measured and recorded perioperatively at the 12(th)h postoperatively. The preoperative and postoperative hemoglobin, hematocrit values, serum creatinine, activated thromboplastin time, prothombin time, thrombocyte count, fibrinogen, D-dimer, and symptoms of pulmonary embolism were comparatively evaluated. RESULTS The tranexamic acid significantly reduced the quantity of total blood loss, 576 ± 53 mL in study group as compared to 823 ± 74 mL in the control group (P<0.01). Postoperatively hematocrit values were higher in the tranexamic acid group. The coagulation profile did not differ between the groups, but D-dimer concentrations were increased in the control group. No complications or adverse effects were reported in the either group. CONCLUSION The prophylactic administration of tranexamic acid has effectively reduced theblood loss and transfusion needs during radical surgery without any adverse effects or complication of thrombosis.
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Affiliation(s)
- Kumkum Gupta
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Bhawna Rastogi
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Atul Krishan
- Department of Surgery, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Amit Gupta
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
| | - V P Singh
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Salony Agarwal
- Department of Anaesthesiology and Critical Care, N.S.C.B. Subharti Medical College, Subhartipuram, Meerut, Uttar Pradesh, India
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72
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Emara WM, Moez KK, Elkhouly AH. Topical versus intravenous tranexamic acid as a blood conservation intervention for reduction of post-operative bleeding in hemiarthroplasty. Anesth Essays Res 2015; 8:48-53. [PMID: 25886103 PMCID: PMC4173581 DOI: 10.4103/0259-1162.128908] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: This study was performed to test the effectiveness of topical tranexamic acid (TXA) in reducing blood loss in pelvic hemiarthoplasty surgeries compared with intravenous TXA, regarding the incidence of thromboembolic complications (deep vein thrombosis [DVT], pulmonary embolism (PE) and cerebrovascular stroke [CVS]). Patients and Methods: After obtaining institutional ethical approval 60 patients divided into three groups. Group A: Received intravenous TXA Group B: Received topical TXA Group C: Control group (placebo saline). All patients were received general anesthesia and post-operative bleeding, immediate and 24 h post-operatively, hemoglobin concentration, hematocrit, platelets and coagulation profile (prothrombin time, activated partial thromboplastin time and international normalized ratio) baseline, immediate and 24 h post-operatively. Thromboelastography was recorded baseline, immediate and 24 h post-operatively. Incidence of DVT, PE and CVS was recorded. Results: There was statistical significant elevation hemoglobin concentration and hematocrit in both Groups A and B, significant increase in blood loss in Group C, significant increase in number of patients receiving blood in Group C, there was a significant decrease in “r” and “k” times and a significant increase in maximum amplitude and α-angle in Group A, statistically significant increase in the incidence of thromboembolic events in the form of DVT, PE and CVS in Group A. Conclusion: Topical TXA is effective in decreasing post-operative blood loss with possible side-effects of this route of administration.
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Affiliation(s)
- Walid Mohamed Emara
- Department of Anesthesia, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Khaled K Moez
- Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt
| | - Abeer H Elkhouly
- Department of Anesthesia, National Cancer Institute, Cairo University, Giza, Egypt
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73
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One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration. Arch Orthop Trauma Surg 2015; 135:573-88. [PMID: 25739992 DOI: 10.1007/s00402-015-2189-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) in orthopedics has recently been gaining favor due to its efficacy and ease of use, both in intravenous (IV) and intraarticular (IA) usage. However, because of safety concerns with IV administration, there has been a growing interest in the IA use of TXA to prevent bleeding. MATERIALS AND METHODS This study conducted a systematic review and meta-analysis that included 31 randomized, controlled trials in which the effect of systemic and topical TXA on total blood loss (TBL), rates of transfusion, and thromboembolic events was investigated. RESULTS Compared to the control, the IA administration of TXA led to the significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and reduction of rate of thromboembolic events (p = 0.29). Compared to the control group, the IV administration of TXA resulted in significant reduction of mean TBL (p < 0.001), rate of transfusion (p < 0.001), and rate of thromboembolic events (p = 0.66). Although no significant differences in efficacy and safety between the IA and IV administration of TXA were found, the IA method was safer than the IV method in that it reduced rate of transfusion and thromboembolic events. CONCLUSION This study showed that TXA leads to significant reductions in TBL and the rate of allogeneic transfusions. Generally, no significant difference was detected between IA and IV administration of TXA; however, more studies with focus on safety and efficacy are warranted.
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74
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Kundu R, Das A, Basunia SR, Bhattacharyya T, Chattopadhyay S, Mukherjee A. Does a single loading dose of tranexamic acid reduce perioperative blood loss and transfusion requirements after total knee replacement surgery? A randomized, controlled trial. J Nat Sci Biol Med 2015; 6:94-9. [PMID: 25810643 PMCID: PMC4367077 DOI: 10.4103/0976-9668.149099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Total knee replacement (TKR) is associated with high-perioperative blood loss, which often requires allogenic blood transfusion. Among the many strategies to decrease the need for allogenic transfusion, tranexamic acid (TA) is used systemically in perioperative setting with promising outcome. Here we evaluated the efficacy of single preoperative bolus dose of TA on reduction in blood loss and red blood cell transfusion in patients undergoing unilateral TKR. Materials and Methods: 70, American Society of Anesthesiologists I-II patients scheduled for unilateral TKR were included. Patients were randomly allocated into two groups to receive either TA (Group-TA; 20 mg/kg diluted to 25 cc with normal saline) or an equivalent volume of normal saline (Group P). Hemoglobin concentration, packed cell volume, platelet count, fibrinogen level, D-dimer level was measured preoperatively and at 6th and 24th h postoperative period. Results: In Group P more blood, colloid and crystalloid solutions were used to replace the blood loss. 27 patients in Group TA did not require transfusion of any blood products compared to 6 patients in Group P (P < 0.0001) and only 3 units of blood was transfused in Group TA where as a total of 32 units of blood was transfused in Group P. Despite the more numerous transfusions, Hb% after 6 h and 24 h in Group P were considerably low in comparison with Group TA (P < 0.0001). Conclusion: Tranexamic acid while significantly reducing blood loss caused by TKR surgery collaterally reduced the need for postoperative blood transfusion.
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Affiliation(s)
- Ratul Kundu
- Department of Anaesthesiology, Institute of Post Graduate Medical Education and Research, Bankura, India
| | - Anjan Das
- Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India
| | - Sandip Roy Basunia
- Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India
| | - Tapas Bhattacharyya
- Department of Anaesthesiology, College of Med and Sagore Dutta Hospital, Bankura, India
| | | | - Anindya Mukherjee
- Department of Anaesthesiology, N. R. S Medical College and Hospital, Kolkata, West Bengal, India
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75
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Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology 2015; 122:241-75. [PMID: 25545654 DOI: 10.1097/aln.0000000000000463] [Citation(s) in RCA: 451] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abstract
The American Society of Anesthesiologists Committee on Standards and Practice Parameters and the Task Force on Perioperative Blood Management presents an updated report of the Practice Guidelines for Perioperative Blood Management.
Supplemental Digital Content is available in the text.
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76
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Vel R, Udupi BP, Satya Prakash MVS, Adinarayanan S, Mishra S, Babu L. Effect of low dose tranexamic acid on intra-operative blood loss in neurosurgical patients. Saudi J Anaesth 2015; 9:42-8. [PMID: 25558198 PMCID: PMC4279349 DOI: 10.4103/1658-354x.146304] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Blood loss is often a major complication in neurosurgery that requires transfusion of multiple units of blood. The purpose of this study was to assess the effect of tranexamic acid (TXA) on intraoperative blood loss and the need for blood transfusion in patients undergoing craniotomy for tumor excision. Materials and Methods: A total of 100 patients aged 18-60 years, with American Society of Anesthesiologists physical Status 1 and 2 scheduled to undergo elective craniotomy for tumor excision were enrolled. Patients received 10 mg/kg bolus about 20 min before skin incision followed by 1 mg/kg/h infusion of either TXA or saline. Hemodynamic variables, intravenous fluid transfused, amount of blood loss and blood given were measured every 2 h. Laboratory parameters such as serum electrolytes and fibrinogen values were measured every 3 h. On the 5th postoperative day hemoglobin (POD Hb5), Hb estimation was done and the estimated blood loss (EBL) calculated. Patients were also monitored for any complications. Results: The Mean heart rate in TXA group was significantly lower compared with the saline group. Mean arterial pressure and fibrinogen levels were higher in TXA group. The mean total blood loss in the TXA group was less than in the saline group. Blood transfusion requirements were comparable in two groups. The EBL and POD5 Hb were comparable in two groups. Conclusion: Even though, there is a significant reduction in the total amount of blood loss in TXA group. However, there was no reduction in intraoperative transfusion requirement.
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Affiliation(s)
- Ramya Vel
- Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
| | | | | | | | - Sandeep Mishra
- Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
| | - Lenin Babu
- Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
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77
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Is tranexamic acid clinically effective and safe to prevent blood loss in total knee arthroplasty? A meta-analysis of 34 randomized controlled trials. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:525-41. [DOI: 10.1007/s00590-014-1568-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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Alshryda S, Sukeik M, Sarda P, Blenkinsopp J, Haddad FS, Mason JM. A systematic review and meta-analysis of the topical administration of tranexamic acid in total hip and knee replacement. Bone Joint J 2014; 96-B:1005-15. [PMID: 25086114 DOI: 10.1302/0301-620x.96b8.33745] [Citation(s) in RCA: 240] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Intravenous tranexamic acid (TXA) has been shown to be effective in reducing blood loss and the need for transfusion after joint replacement. Recently, there has been interest in applying it topically before the closure of surgical wounds. This has the advantages of ease of application, maximum concentration at the site of bleeding, minimising its systemic absorption and, consequently, concerns about possible side-effects. We conducted a systematic review and meta-analysis which included 14 randomised controlled trials (11 in knee replacement, two in hip replacement and one in both) which investigated the effect of topical TXA on blood loss and rates of transfusion. Topical TXA significantly reduced the rate of blood transfusion (total knee replacement: risk ratio (RR) 4.51; 95% confidence interval (CI): 3.02 to 6.72; p < 0.001 (nine trials, I(2) = 0%); total hip replacement: RR 2.56; 95% CI: 1.32 to 4.97, p = 0.004 (one trial)). The rate of thromboembolic events with topical TXA were similar to those found with a placebo. Indirect comparison of placebo-controlled trials of topical and intravenous TXA indicates that topical administration is superior to the intravenous route. In conclusion, topical TXA is an effective and safe method of reducing the need for blood transfusion after total knee and hip replacement. Further research is required to find its optimum dose for topical use.
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Affiliation(s)
- S Alshryda
- Central Manchester Hospitals, Oxford Road, Manchester, M13 9WL, UK
| | - M Sukeik
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK
| | - P Sarda
- Medway Maritime Hospital, Windmill Road, Gillingham, Kent, ME7 5NY, UK
| | - J Blenkinsopp
- University Hospital of North Tees and Hartlepool, Hardwick Road, Stockton-On-Tees TS19 8PE, UK
| | - F S Haddad
- University College London Hospitals, 235 Euston Road, London, NW1 2BU, UK
| | - J M Mason
- Durham University, Durham Clinical Trials Unit, University Boulevard, Stockton-On-Tees, TS17 6BH, UK
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79
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Levine BR, Haughom BD, Belkin MN, Goldstein ZH. Weighted versus uniform dose of tranexamic acid in patients undergoing primary, elective knee arthroplasty: a prospective randomized controlled trial. J Arthroplasty 2014; 29:186-8. [PMID: 24997651 DOI: 10.1016/j.arth.2014.01.038] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 01/12/2014] [Accepted: 01/19/2014] [Indexed: 02/01/2023] Open
Abstract
In a prospective, randomized, double-blinded, controlled study (25 controls), TA was infused parenterally before tourniquet release in two study groups. Group 1 (n = 20) received a 1 g dose, and group 2 (n = 20) received a 20 mg/kg dose. There was no significant difference between groups 1 and 2 with intra-operative, post-operative and total blood loss. Both groups 1 and 2 exhibited significant improvements in intra-operative, post-operative, and total blood loss compared to the control group (P < 0.05). Two blood transfusions were given to one patient in the weighted group, compared to 19 transfusions (10 patients) in the control group. This study suggests that a single 1-g dose can be used with the same efficacy as a weighted 20 mg/kg dose.
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80
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Alshryda S, Mason JM, Sarda P, Lou T, Stanley M, Wu J, Unsworth A. The effect of tranexamic acid on artificial joint materials: a biomechanical study (the bioTRANX study). J Orthop Traumatol 2014; 16:27-34. [PMID: 25091616 PMCID: PMC4348525 DOI: 10.1007/s10195-014-0312-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 06/28/2014] [Indexed: 12/22/2022] Open
Abstract
Background Tranexamic acid (TXA) has been successfully used to reduce bleeding in joint replacement. Recently local TXA has been advocated to reduce blood loss in total knee or hip replacement; however, this raised concerns about potential adverse effects of TXA upon the artificial joint replacement. Materials and methods In this biomechanical study we compared the effects of TXA and saline upon the following biomechanical properties of artificial joint materials—(1) tensile properties (ultimate strength, stiffness and Young’s modulus), (2) the wear rate using a multi-directional pin-on-plate machine, and (3) the surface topography of pins and plates before and after wear rate testing. Results There were no significant differences in tensile strength, wear rates or surface topography of either ultra-high-molecular-weight polyethylene pins or cobalt chromium molybdenum metal plates between specimens soaked in TXA and specimens soaked in saline. Conclusion Biomechanical testing shows that there are no biomechanical adverse affects on the properties of common artificial joint materials from using topical TXA. Level of evidence V
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Affiliation(s)
- Sattar Alshryda
- Departments of Trauma and Orthopaedics, Central Manchester University Hospitals, Oxford Road, Manchester, M13 9WL, Lancashire, UK,
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81
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Soni A, Saini R, Gulati A, Paul R, Bhatty S, Rajoli SR. Comparison between intravenous and intra-articular regimens of tranexamic acid in reducing blood loss during total knee arthroplasty. J Arthroplasty 2014; 29:1525-7. [PMID: 24814890 DOI: 10.1016/j.arth.2014.03.039] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 03/25/2014] [Accepted: 03/31/2014] [Indexed: 02/01/2023] Open
Abstract
Tranexamic acid is an antifibrinolytic drug used widely to prevent bleeding. Its use in reducing bleeding during total knee arthroplasty surgery is well proven but there is no final consensus regarding the regimen. The purpose of our study was to compare the effectiveness of intravenous and intra-articular regimen of tranexamic acid during the total knee arthroplasty surgery. A total of 40 patients were received three doses of intravenous tranexamic acid during total knee arthroplasty surgery. Intra-articular tranexamic acid was used in 40 patients during the surgery. We concluded that intra-articular tranexamic acid is equally effective as three dose intravenous regimen in reducing blood loss during total knee arthroplasty surgery.
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Affiliation(s)
- Ashwani Soni
- Department of Orthopaedics, GGS Medical College and Hospital, Faridkot, India
| | - Raghav Saini
- Department of Orthopaedics, Shivam Multispecialty Hospital, Hoshiarpur, India
| | - Anmol Gulati
- Department of Orthopaedics, Shivam Multispecialty Hospital, Hoshiarpur, India
| | - Rajesh Paul
- Department of Orthopaedics, GGS Medical College and Hospital, Faridkot, India
| | - Shiraj Bhatty
- Department of Orthopaedics, GGS Medical College and Hospital, Faridkot, India
| | - Sreekanth Reddy Rajoli
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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82
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Kim TK, Chang CB, Koh IJ. Practical issues for the use of tranexamic acid in total knee arthroplasty: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22:1849-58. [PMID: 23542923 DOI: 10.1007/s00167-013-2487-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 03/22/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE This systematic review was undertaken to answer three specific questions relating to the clinical values of tranexamic acid (TNA) in total knee arthroplasty (TKA): (1) Whether there are differences in blood-saving effects between the systemic and topical administrations; (2) Whether blood-saving effects of TNA differ by doses and timings of administration; and (3) Whether the use of TNA is safe at all reported doses, timings, and routes of administration with respect to the incidences of symptomatic deep-vein thrombosis (DVT) and pulmonary embolism (PE). METHODS A systematic review was carried out with 28 randomised controlled trials to evaluate the efficacy and safety of TNA use in TKA identified from the literature. RESULTS Both systemic and topical administrations reduced blood loss after TKA, but transfusion reducing effects varied in studies whether systemic or topical administrations. The effects of TNA were influenced by doses and timings of administration. No increased incidences of symptomatic DVT and PE were found for all reported doses, timings, and routes of TNA administration. CONCLUSION Surgeons can consider incorporating the use of TNA to their blood-saving protocols in TKA without serious concern of adverse events but need to adopt optimal doses, timings, and routes of TNA administrations.
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Affiliation(s)
- Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumiro, Bundanggu, Seongnamsi, Gyeonggi-do, 463-707, Republic of Korea,
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Kim TK, Chang CB, Kang YG, Seo ES, Lee JH, Yun JH, Lee SH. Clinical value of tranexamic acid in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2014; 22:1870-8. [PMID: 23592025 DOI: 10.1007/s00167-013-2492-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 12/04/2012] [Indexed: 12/28/2022]
Abstract
PURPOSE Despite the documented blood-saving effects of tranexamic acid (TNA) in total knee arthroplasty (TKA), the question whether clinical values of TNA are identical in unilateral and bilateral TKAs remains unclear. This study was undertaken to determine the clinical values of TNA in unilateral and simultaneous bilateral TKAs under a contemporary blood-saving protocol in terms of efficacy (total blood loss and transfusion rate) and safety (the incidences of symptomatic deep vein thrombosis and pulmonary embolism). METHODS One hundred and eighty unilateral and 146 bilateral TKA patients were randomized into TNA group or control group. In unilateral TKA patients, TNA (10 mg/kg) was administered intravenously 20 min before tourniquet deflation and repeated 3 h after surgery. In bilateral TKA patients, one more dose (10 mg/kg) was given before tourniquet deflation in the second TKA. A contemporary blood-saving protocol was applied to all patients. The TNA and control groups were compared separately in unilateral and bilateral TKA patients for the efficacy and safety variables. RESULTS In unilateral TKA patients, the TNA group had less total blood loss (905 vs. 1,018 mL, p = 0.018) than the control group, but there was no difference in the allogenic transfusion rate (1 vs. 7 %, n.s.). In bilateral TKA patients, the TNA group showed no differences in total blood loss (1,282 vs. 1,379 mL, n.s.), but a significant reduction in the allogenic transfusion rate (7 vs. 27 %, p = 0.002). No symptomatic deep vein thrombosis or pulmonary embolism was found in all patients. CONCLUSION This study demonstrates that the use of TNA reduces total blood loss, but the effects on the transfusion rate can differ depending on the type of TKAs (unilateral vs. bilateral) and the blood-saving protocols.
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Affiliation(s)
- Tae Kyun Kim
- Joint Reconstruction Center, Seoul National University Bundang Hospital, 166 Gumiro, Bundanggu, Seongnamsi, 463-707, Gyeonggido, Republic of Korea,
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Rasouli MR, Gomes LSM, Parsley B, Barsoum W, Bezwada H, Cashman J, Garcia J, Hamilton W, Hume E, Malhotra R, Memtsoudis S, Ong A, Orozco F, Padgett D, Reina R, Teloken M, Thienpont E, Waters JH. Blood conservation. J Orthop Res 2014; 32 Suppl 1:S81-9. [PMID: 24464900 DOI: 10.1002/jor.22551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Sambandam B, Batra S, Gupta R, Agrawal N. Blood conservation strategies in orthopedic surgeries: A review. J Clin Orthop Trauma 2013; 4:164-70. [PMID: 26403876 PMCID: PMC3880946 DOI: 10.1016/j.jcot.2013.11.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022] Open
Abstract
In orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits.
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Affiliation(s)
- Balaji Sambandam
- Senior Resident, Lok Nayak Hospital, New Delhi, India,Corresponding author.
| | - Sahil Batra
- Senior Resident, Lok Nayak Hospital, New Delhi, India
| | - Rajat Gupta
- Senior Resident, Lok Nayak Hospital, New Delhi, India
| | - Nidhi Agrawal
- Specialist Anesthesia, V.M.M.C. & Safdarjung Hospital, New Delhi, India
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Alshryda S, Mason J, Vaghela M, Sarda P, Nargol A, Maheswaran S, Tulloch C, Anand S, Logishetty R, Stothart B, Hungin APS. Topical (intra-articular) tranexamic acid reduces blood loss and transfusion rates following total knee replacement: a randomized controlled trial (TRANX-K). J Bone Joint Surg Am 2013; 95:1961-8. [PMID: 24196466 DOI: 10.2106/jbjs.l.00907] [Citation(s) in RCA: 129] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately one-third of patients undergoing total knee replacement require one to three units of blood postoperatively. Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has been successfully used intravenously to stop bleeding after total knee replacement. A topical application is easy to administer, provides a maximum concentration of tranexamic acid at the bleeding site, and is associated with little or no systemic absorption of the tranexamic acid. METHODS A double-blind, randomized controlled trial of 157 patients undergoing unilateral primary cemented total knee replacement investigated the effect of topical (intra-articular) application of tranexamic acid on blood loss. The primary outcome was the blood transfusion rate. Secondary outcomes included the drain blood loss, hemoglobin concentration drop, generic quality of life (EuroQol), Oxford Knee Score, length of stay, a cost analysis, and complications as per the protocol definitions. RESULTS Tranexamic acid reduced the absolute risk of blood transfusion by 15.4% (95% confidence interval [CI], 7.5% to 25.4%; p = 0.001), from 16.7% to 1.3%, and reduced blood loss by 168 mL (95% CI, 80 to 256 mL; p = 0.0003), the length of stay by 1.2 days (95% CI, 0.05 to 2.43 days; p = 0.041), and the cost per episode by £333 (95% CI, £37 to £630; p = 0.028). (In 2008, £1 = 1.6 U.S. dollars.) Oxford Knee Scores and EuroQol EQ-5D scores were similar at three months. CONCLUSIONS Topically applied tranexamic acid was effective in reducing the need for blood transfusion following total knee replacement without important additional adverse effects. LEVEL OF EVIDENCE Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sattar Alshryda
- The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, United Kingdom. E-mail address:
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Lee SH, Cho KY, Khurana S, Kim KI. Less blood loss under concomitant administration of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty: a prospective randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2013; 21:2611-7. [PMID: 23052111 DOI: 10.1007/s00167-012-2213-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 09/14/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this prospective randomized controlled trial was to assess the efficacy and safety of simultaneous application of tranexamic acid and indirect factor Xa inhibitor following total knee arthroplasty (TKA). METHODS Seventy-two primary osteoarthritis patients undergoing unilateral TKA using fondaparinux as a basic thromboprophylaxis were randomized to receive either placebo (36 patients) or tranexamic acid (36 patients). Prophylaxis against venous thromboembolism in all patients was administered with subcutaneous doses of 2.5 mg fondaparinux for 5 days post-operatively. Post-operative retransfusion volume, allogenic transfusion volumes and drain amount were recorded for each patient. Level of haemoglobin, prothrombin time, activated partial thromboplastin time and D-dimer were also assessed. Doppler ultrasonography was performed preoperatively and 7 days after surgery. RESULTS The rate of transfusion was lower in the tranexamic acid group than in the placebo group (p = 0.007). The drained blood volume during the initial 24 h and until drain removal was smaller in the tranexamic acid group than in the placebo group (p < 0.001). However, the haematologic laboratory results did not show any significant differences between the two groups. The prevalence of deep-vein thrombosis (DVT) was 4 (11.1 %) in the placebo group and 3 (8.3 %) in the tranexamic acid group (p = n.s.). There was no proximal DVT and no symptomatic pulmonary embolism in either group. CONCLUSION The use of tranexamic acid could reduce acute blood loss significantly without any adverse effect resulted from drug interaction with concomitant use of indirect factor Xa inhibitor following TKA. Therefore, simple combination of these drugs can be recommended to reduce post-operative blood loss as well as to reduce DVT following TKA.
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Affiliation(s)
- Sang Hak Lee
- Department of Orthopedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, 149 Sangil-dong, Gangdong-gu, Seoul, 134-090, Korea
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Tan J, Chen H, Liu Q, Chen C, Huang W. A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty. J Surg Res 2013; 184:880-7. [DOI: 10.1016/j.jss.2013.03.099] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 03/02/2013] [Accepted: 03/28/2013] [Indexed: 11/16/2022]
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Huang F, Wu D, Ma G, Yin Z, Wang Q. The use of tranexamic acid to reduce blood loss and transfusion in major orthopedic surgery: a meta-analysis. J Surg Res 2013; 186:318-27. [PMID: 24075404 DOI: 10.1016/j.jss.2013.08.020] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/16/2013] [Accepted: 08/20/2013] [Indexed: 12/26/2022]
Abstract
BACKGROUND Conflicting reports have been published regarding the effect of tranexamic acid (TXA) on reducing blood loss and transfusion in patients undergoing orthopedic surgery. We performed a meta-analysis to evaluate the effectiveness and safety of TXA treatment in reducing blood loss and transfusion in major orthopedic surgery. MATERIALS AND METHODS MEDLINE, PubMed, EMBASE, and Cochrane databases were searched for relevant studies. Only randomized controlled trials were eligible for this study. The weighted mean difference in blood loss, number of transfusions per patient, and the summary risk ratio of transfusion and deep vein thrombosis (DVT) were calculated in the TXA-treated group and the control group. RESULTS A total of 46 randomized controlled trials involving 2925 patients were included. The use of TXA reduced total blood loss by a mean of 408.33 mL (95% confidence interval [CI], -505.69 to -310.77), intraoperative blood loss by a mean of 125.65 mL (95% CI, -182.58 to -68.72), postoperative blood loss by a mean of 214.58 mL (95% CI, -274.63 to -154.52), the number of blood transfusions per patient by 0.78 U (95% CI, -0.19 to -0.37), and the volumes of blood transfusions per patient by 205.33 mL (95% CI, -301.37 to -109.28). TXA led to a significant reduction in transfusion requirements (relative risk, 0.51; 95% CI, 0.46-0.56), and no increase in the risk of DVT (relative risk, 1.11; 95% CI, 0.69-1.79). CONCLUSIONS TXA significantly reduced blood loss and blood transfusion requirements in patients undergoing orthopedic surgery, and did not appear to increase the risk of DVT.
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Affiliation(s)
- Fei Huang
- Department of Orthopaedics, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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91
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Ker K, Prieto-Merino D, Roberts I. Systematic review, meta-analysis and meta-regression of the effect of tranexamic acid on surgical blood loss. Br J Surg 2013; 100:1271-9. [DOI: 10.1002/bjs.9193] [Citation(s) in RCA: 169] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2013] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Tranexamic acid (TXA) reduces blood transfusion in surgery but the extent of the reduction in blood loss and how it relates to the dose of TXA is unclear.
Methods
A systematic review of randomized trials was performed. Data were extracted on blood loss from trials comparing intravenous TXA with no TXA or placebo in surgical patients. A Bayesian linear regression was used to describe the relationship between the reduction in blood loss with TXA and the extent of bleeding as measured by the mean blood loss in the control group. A meta-analysis of the log-transformed data was conducted to quantify the effect of TXA on blood loss, stratified by type of surgery, timing of TXA administration and trial quality. Meta-regression was used to explore the effect of TXA dosage.
Results
Data from 104 trials were examined. Although the absolute reduction in blood loss with TXA increased as surgical bleeding increased, the percentage reduction was similar. TXA reduced blood loss by 34 per cent (pooled ratio 0·66, 95 per cent confidence interval 0·65 to 0·67; P < 0·001). The percentage reduction in blood loss with TXA differed by type of surgery, timing of TXA administration and trial quality, but the differences were small. The effect of TXA on blood loss did not vary over the range of doses assessed (5·5–300 mg/kg).
Conclusion
TXA reduces blood loss in surgical patients by about one-third. A total dose of 1 g appears to be sufficient for most adults. There is no evidence to support the use of high doses.
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Affiliation(s)
- K Ker
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - D Prieto-Merino
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - I Roberts
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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92
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Vijay BS, Bedi V, Mitra S, Das B. Role of tranexamic acid in reducing postoperative blood loss and transfusion requirement in patients undergoing hip and femoral surgeries. Saudi J Anaesth 2013; 7:29-32. [PMID: 23717228 PMCID: PMC3657919 DOI: 10.4103/1658-354x.109803] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Pharmacological agents are used to reduce postoperative blood loss. AIMS To assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major hip and femoral surgeries. SETTINGS AND DESIGN A prospective, randomized, double blinded study was conducted in the tertiary care teaching hospital. METHODS Ninety ASA grade I-II patients undergoing hip fracture surgery were included in this prospective study. Forty-five patients received tranexamic acid (TA) given in a bolus dose of 500 mg 15 min before surgical incision followed by continuous infusion. The remaining, 45 patients were allocated as a control group. Postoperative bleeding (volume of blood in the drain), percentage fall of hemoglobin, transfusions and complications were recorded. RESULTS Mean volume of blood in the drain was 39.33±10.09 ml (mean±SD) as compared to 91.11±17.61 ml in placebo group showing a P<0.001. Mean percentage fall in Hb at day 0 was 2.99±3.45 in the study group as compared to 7.70±6.05 in the placebo group (P<0.001), and fall at day 2 in the study group was 0.35±0.74, compared to 2.72±2.70 in the placebo group (P<0.001). The number of patients required blood transfusions were lower in the study group than in the placebo group (P=0.01). CONCLUSIONS We conclude that tranexamic acid significantly reduces postoperative blood loss and transfusion requirements during major hip and femoral surgeries.
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Affiliation(s)
- Bhavani S Vijay
- Department of Anaesthesiology, Jawaharlal Nehru Medical College, A.M.U. Aligarh, India
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93
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The effect of bolus administration of tranexamic acid in revision hip arthroplasty. Hip Int 2013; 22:615-20. [PMID: 23233173 DOI: 10.5301/hip.2012.10143] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 02/04/2023]
Abstract
We assessed the efficacy of tranexamic acid in reducing transfusion requirements in patients undergoing revision hip arthroplasty. A prospective cohort study was designed comparing Tranexamic acid administration in 30 patients compared to 30 patients in a control group. Blood loss was measured in theatre, pre- and postoperative haemoglobin measurements were recorded and postoperative haemodynamic parameters were evaluated. The mean postoperative haemoglobin was 9.5 g/dl in the tranexamic acid group and 8.2 g/dl in the control group (p<0.01). The mean haemoglobin reduction was 2.7 g/dl in the tranexamic acid group and 3.4 g/dl in the control group (p = 0.47). Mean transfusion requirements were 2.76 units in the study group and 4.0 units in the control group (p = 0.49) and the frequency of transfusion was reduced (p = 0.032). Infected revisions showed no reduction in transfusion requirements with tranexamic acid administration (p = 0.25). There was a reduced frequency of transfusion in patients when revision was performed for aseptic loosening (p = 0.027). This group of patients may benefit from tranexamic acid administration.
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Gandhi R, Evans HMK, Mahomed SR, Mahomed NN. Tranexamic acid and the reduction of blood loss in total knee and hip arthroplasty: a meta-analysis. BMC Res Notes 2013; 6:184. [PMID: 23651507 PMCID: PMC3655041 DOI: 10.1186/1756-0500-6-184] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 04/30/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic drug used as a blood-sparing technique in many surgical specialties. The principal objective of our meta-analysis was to review randomized, controlled trials (RCT) comparing total blood loss and the number of patients receiving allogeneic blood transfusions with and without the use of TXA for knee (TKA) and hip (THA) arthroplasty. METHODS Studies were included if patients underwent primary unilateral TKA or THA; the study involved the comparison of a TXA treatment group to a control group who received either a placebo or no treatment at all; outcome measures included total blood loss TBL, number of patients receiving allogeneic blood transfusions, and/or incidence of thromboembolic complications; the study was a published or unpublished RCT from 1995 - July 2012. RESULTS Data were tested for publication bias and statistical heterogeneity. Combined weighted mean differences in blood loss favoured TXA over control for TKA and THA patients respectively [ -1.149 (p < 0.001; 95% CI -1.298, -1.000), -0.504 (p < 0.001; 95% CI, -0.672, -0.336)]. Combined odds ratios favoured fewer patients requiring allogeneic transfusions for TKA and THA with the use of TXA respectively [0.145 (p < 0.001; 95% CI, 0.094, 0.223), 0.327 (p < 0.001; 95% CI, 0.208, 0.515)]. Combined odds ratios indicated no increased incidence of DVT with TXA use in TKA and THA respectively [1.030 (p = 0.946; 95% CI, 0.439, 2.420), 1.070 (p = 0.895; 95% CI, 0.393, 2.911)]. CONCLUSIONS TXA should be considered for routine use in primary knee and hip arthroplasty to decrease blood loss.
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Affiliation(s)
- Rajiv Gandhi
- Department of Orthopaedic Surgery, Toronto Western Hospital, 399 Bathurst St, 1-439 East Wing, Toronto, Ontario, Canada.
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95
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Tranexamic acid for reducing blood transfusions in arthroplasty interventions: a cost-effective practice. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:545-51. [DOI: 10.1007/s00590-013-1225-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 04/14/2013] [Indexed: 11/27/2022]
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Gautam PL, Katyal S, Yamin M, Singh A. Effect of tranexamic acid on blood loss and transfusion requirement in total knee replacement in the Indian population: A case series. Indian J Anaesth 2013; 55:590-3. [PMID: 22223903 PMCID: PMC3249866 DOI: 10.4103/0019-5049.90614] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
CONTEXT Total knee replacement (TKR) is often carried out using a tourniquet to minimize intraoperative blood loss. However, its application enhances local fibrinolysis, resulting in excessive blood loss during the post-operative period. Fibrinolytic profile varies in different regions and races. Tranexamic acid has been shown to reduce post-operative blood loss and the need for transfusion in TKR. However, there is paucity of literature from the Indian population and the efficacy of the agent has not been tested in Indian patients undergoing TKR. AIMS Effect of tranexamic acid on blood loss in TKR surgery in the Indian population. SETTING AND DESIGN In this double-blinded study, 40 patients undergoing unilateral TKR were randomly divided into two groups. METHODS All patients were conducted under spinal anaesthesia using injection bupivacaine 0.5% heavy 12-15 mg. The treatment group received 10 mg/kg tranexamic acid, intravenous (IV), half an hour before deflation of the tourniquet, with a second dose of 2 mg/kg administered 3 hours after the first dose. The exact protocol was followed for the placebo group, except that normal saline was used instead of tranexamic acid. Blood loss, blood transfusion details and change in haemoglobin levels were noted. STATISTICAL ANALYSIS Student's paired 't' test was used in statistical analysis. RESULTS The mean post-operative blood loss in the tranexamic acid group was 272.5±122.5 ml (mean±SD), and 685±118.2 ml in the placebo group (P<0.001). The total blood loss was lower in the tranexamic acid group than in the placebo group (427.6 ml vs. 911.6 ml; P<0.001). The absolute number of blood transfusions and the number of patients who required transfusions were lower in the tranexamic acid group than in the placebo group. None of the patients had any side or adverse effect. CONCLUSIONS Tranexamic acid significantly decreases post-operative blood loss and reduces the need for blood transfusion in patients undergoing TKR.
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Affiliation(s)
- Parshotam Lal Gautam
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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97
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Can local administration of tranexamic acid during total knee arthroplasty reduce blood loss and transfusion requirements in the absence of surgical drains? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:379-84. [DOI: 10.1007/s00590-013-1206-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
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98
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Gibon E, Courpied JP, Hamadouche M. Total joint replacement and blood loss: what is the best equation? INTERNATIONAL ORTHOPAEDICS 2013; 37:735-9. [PMID: 23385607 DOI: 10.1007/s00264-013-1801-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/15/2013] [Indexed: 12/26/2022]
Abstract
With the population aging, total joint replacements which are an effective method to restore patient's mobility are an increasing necessity. However, such operations are known to entail serious blood loss, which may have dramatic consequences in patients with chronic diseases or when the prosthesis is revised, a situation where the blood loss is even higher. Therefore, formulas to better estimate the blood loss are available. These formulas may also be used for clinical studies to compare blood loss between different joint replacement techniques. The aim of this review is to provide a clear understanding of the formulas and to help physicians to further improve their blood loss estimation. Moreover, surgeons will then be able to choose the most accurate and user-friendly formula for more comparable data between clinical studies.
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Affiliation(s)
- Emmanuel Gibon
- Department of Orthopaedic and Reconstructive Surgery, Clinical Orthopaedic Research Centre, Service A, Cochin Teaching Hospital, Paris School of Medicine, 27 rue du Faubourg Saint Jacques, 75014, Paris, France.
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Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:2494-501. [PMID: 22419263 DOI: 10.1007/s00167-012-1942-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
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 prospective, double-blinded, randomized 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 randomly 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.
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100
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Zhang H, Chen J, Chen F, Que W. The effect of tranexamic acid on blood loss and use of blood products in total knee arthroplasty: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2012; 20:1742-52. [PMID: 22065294 DOI: 10.1007/s00167-011-1754-z] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Accepted: 10/25/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Studies have shown that tranexamic acid (TXA) reduces blood loss and transfusion need in patients undergoing total knee arthroplasty (TKA). However, no single study has been large enough to definitively determine whether the drug is safe and effective. We report a systematic review and meta-analysis of randomised controlled trials evaluating the efficacy and safety of TXA in reducing blood loss and transfusion in TKA. METHODS A comprehensive literature search was done in Cochrane Library, MEDLINE, EMBASE, and CNKI. Two reviewers independently identified the eligible studies, assessed their methodological quality, and extracted data. The data were evaluated using the generic evaluation tool designed by the Cochrane Bone, Joint and Muscle Trauma Group. The relevant data were analyzed using RevMan 5.0. RESULTS Fifteen randomized controlled trials involving 842 patients were included. The use of TXA reduced total blood loss by a mean of 487 ml [95% confidence interval (CI) -629 to -344], intra-operative blood loss by a mean of 127 ml (95% CI -313-59), and post-operative blood loss by a mean of 245 ml (95% CI -410 to -80). TXA led to a significant reduction in the proportion of patients requiring blood transfusion (risk difference -0.4). There were no significant differences in deep-vein thrombosis (DVT), pulmonary embolism, or other complications among the study groups. CONCLUSION Meta-analysis indicates that TXA may reduce post-operative, total blood loss and transfusion in patients undergoing TKA. TXA led to a significant reduction in the proportion of patients requiring blood transfusion. LEVEL OF EVIDENCE Therapeutic study (Systematic review of Level I studies with inconsistent results), Level II.
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Affiliation(s)
- Haoran Zhang
- Department of Hematology and Rheumatology, The First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou 350005, Fujian Province, China
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