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Nemoto A, Mizuno K, Goyagi T. The Effect of Tranexamic Acid Administration on Perioperative Bleeding in Patients Undergoing Knee or Hip Arthroplasty: A Single-Centre Retrospective Study. Turk J Anaesthesiol Reanim 2019; 48:142-147. [PMID: 32259146 PMCID: PMC7101183 DOI: 10.5152/tjar.2019.08364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 08/06/2019] [Indexed: 01/13/2023] Open
Abstract
Objective Tranexamic acid (TXA) has been used to reduce perioperative bleeding in various surgeries because of its antifibrinolytic effect. Recently, patients undergoing orthopaedic surgery in our institution received a loading dose of TXA (10 00 mg) before surgery, followed by 100 mg h−1 until the end of surgery. The purpose of the present study was to evaluate the efficacy of TXA administration on the perioperative blood loss in patients undergoing knee arthroplasty or hip arthroplasty. Methods A retrospective cross-sectional study was conducted for the records in patients who underwent surgery without TXA administration (control group) and patients who underwent surgery with TXA administration (TXA group). Amount of intraoperative blood loss, intraoperative infusion volume, intraoperative blood transfusion volume, postoperative blood transfusion volume, changes in haemoglobin concentrations (ΔHb) and estimated blood loss were collected. Data were adjusted by propensity score method. Results A total of 126 (63 in the control group and 63 in the TXA group) patients were included during the study period. Intraoperative infusion, postoperative transfusion, ΔHb and estimated blood loss were significantly reduced in the TXA group, although there were no significant differences in the volumes of intraoperative transfusion and blood loss. Conclusion The administration of TXA (loading dose of 1000 mg and continuous infusion of 100 mg h−1) reduced postoperative transfusion and perioperative blood loss. These results indicated that TXA administration is useful for reducing perioperative blood loss in patients undergoing knee or hip arthroplasty.
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Affiliation(s)
- Akira Nemoto
- Department of Anaesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Kana Mizuno
- Department of Anaesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Toru Goyagi
- Department of Anaesthesia and Intensive Care Medicine, Akita University Graduate School of Medicine, Akita, Japan
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102
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Fillingham YA, Darrith B, Calkins TE, Abdel MP, Malkani AL, Schwarzkopf R, Padgett DE, Culvern C, Sershon RA, Bini S, Della Valle CJ. 2019 Mark Coventry Award: A multicentre randomized clinical trial of tranexamic acid in revision total knee arthroplasty: does the dosing regimen matter? Bone Joint J 2019; 101-B:10-16. [PMID: 31256650 DOI: 10.1302/0301-620x.101b7.bjj-2018-1451.r1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Tranexamic acid (TXA) is proven to reduce blood loss following total knee arthroplasty (TKA), but there are limited data on the impact of similar dosing regimens in revision TKA. The purpose of this multicentre randomized clinical trial was to determine the optimal regimen to maximize the blood-sparing properties of TXA in revision TKA. PATIENTS AND METHODS From six-centres, 233 revision TKAs were randomized to one of four regimens: 1 g of intravenous (IV) TXA given prior to the skin incision, a double-dose regimen of 1 g IV TXA given both prior to skin incision and at time of wound closure, a combination of 1 g IV TXA given prior to skin incision and 1 g of intraoperative topical TXA, or three doses of 1950 mg oral TXA given two hours preoperatively, six hours postoperatively, and on the morning of postoperative day one. Randomization was performed based on the type of revision procedure to ensure equivalent distribution among groups. Power analysis determined that 40 patients per group were necessary to identify a 1 g/dl difference in the reduction of haemoglobin postoperatively between groups with an alpha of 0.05 and power of 0.80. Per-protocol analysis involved regression analysis and two one-sided t-tests for equivalence. RESULTS In total, one patient withdrew, five did not undergo surgery, 16 were screening failures, and 25 did not receive the assigned treatment, leaving 186 patients for analysis. There was no significant difference in haemoglobin reduction among treatments (2.8 g/dl for single-dose IV TXA, 2.6 g/dl for double-dose IV TXA, 2.6 g/dl for combined IV/topical TXA, 2.9 g/dl for oral TXA; p = 0.38). Similarly, calculated blood loss (p = 0.65) and transfusion rates (p = 0.95) were not significantly different between groups. Equivalence testing assuming a 1 g/dl difference in haemoglobin change as clinically relevant showed that all possible pairings were statistically equivalent. CONCLUSION Despite the higher risk of blood loss in revision TKA, all TXA regimens tested had equivalent blood-sparing properties. Surgeons should consider using the lowest effective dose and least costly TXA regimen in revision TKA. Cite this article: Bone Joint J 2019;101-B(Supple 7):10-16.
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Affiliation(s)
- Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - B Darrith
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - T E Calkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - M P Abdel
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A L Malkani
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Ran Schwarzkopf
- Department of Orthopaedic Surgery, New York University, New York, New York, USA
| | - D E Padgett
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - C Culvern
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - R A Sershon
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - S Bini
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
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103
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Blood loss reduction: effect of different knee prosthesis designs and use of tranexamic acid-a randomized controlled trial. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1519-1524. [PMID: 31119383 DOI: 10.1007/s00590-019-02450-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/17/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE In regard to blood loss in total knee arthroplasty (TKA), the effect of either knee prosthesis designs or bone preparation is still unclear. While the benefit of using tranexamic acid (TXA) is well demonstrated, our study aims to determine the effect of different knee prosthesis designs uses and efficacy of blood loss reduction by different routes of TXA administration. METHODS The 228 patients undergone primary TKA were randomized to determine between open-box and closed-box prosthesis. Among each group, a second randomization was applied to categorize the patients into (1) no use of TXA (No-TXA), (2) intra-articular TXA use (IA-TXA) and (3) intravenous TXA use (IV-TXA). The calculated blood loss (CBL), drain volume (DV) and an average number of units of blood transfused (ANUBT) were blindly evaluated. RESULTS The open-box TKA had 85.60 and 63.29 ml (p = 0.02 and p < 0.01) more CBL and DV compared to closed-box TKA. The IA-TXA and IV-TXA significantly reduced CBL by 190.75 and 162.01 ml (p < 0.01 and p < 0.01) and reduced DV by 129.07 and 61.04 ml (p < 0.01 and p = 0.01), respectively, when compared to No-TXA. Patients who received IA and IV-TXA had ANUBT of 0.21 and 0.23 unit, which was significantly lower than 0.42 unit of No-TXA group (p = 0.03). CONCLUSIONS Use of the different prosthesis designs could significantly affect CBL and DV following TKA. However, the use of either design resulted in a comparable ANUBT. Regardless of prosthetic type, either IA- or IV-TXA could significantly reduce the CBL and ANUBT when compared to No-TXA.
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104
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Wu XD, Xiao PC, Zhu ZL, Liu JC, Li YJ, Huang W. The necessity of routine postoperative laboratory tests in enhanced recovery after surgery for primary hip and knee arthroplasty: A retrospective cohort study protocol. Medicine (Baltimore) 2019; 98:e15513. [PMID: 31045842 PMCID: PMC6504266 DOI: 10.1097/md.0000000000015513] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 04/12/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Over the last few decades, the concepts of minimally invasive surgery and enhanced recovery after surgery (ERAS) protocols have been introduced into the field of total joint arthroplasty (TJA), and tranexamic acid (TXA) has been widely used in TJA. Modern-day surgical techniques and perioperative care pathways of TJA have experienced unexpected improvements. Recently, the necessity of the practice of ordering routine postoperative laboratory tests for patients undergoing primary TJA has been challenged, especially in the context of implementation of ERAS protocols in TJA. These studies have consistently suggested that routine postoperative laboratory tests are not necessary in modern-day primary, unilateral total hip arthroplasty (THA) or total knee arthroplasty (TKA), and laboratory tests after surgery should only be obtained for patients with risk factors. However, it remains unclear whether routine postoperative laboratory tests after THA and TKA remains justified in the Chinese patient population. Therefore, we developed this study to address this issue. METHODS AND ANALYSIS This retrospective cohort study will include adult patients who underwent primary unilateral THA or TKA and received multimodal perioperative care pathways according to ERAS protocols. The following patient data will be collected from the electronic medical record system: patients' demographics, preoperative and postoperative laboratory values, operation time, intraoperative blood loss, TXA use, tourniquet use, postoperative length of stay, and any medical intervention directly related to abnormal laboratory values. The main study outcomes are the incidence of acute anemia requiring transfusion and incidence of hypoalbuminemia requiring albumin supplementation. The secondary outcomes are the rates of acute kidney injury, incidence of abnormal serum sodium level, incidence of abnormal serum potassium level, and incidence of abnormal serum calcium level. These clinical data will be analyzed to determine the incidence of abnormal postoperative laboratory values following primary unilateral THA and TKA; to clarify the frequency of any medical intervention directly related to abnormal postoperative laboratory values; and to identify risk factors that predispose patients to have abnormal postoperative laboratory results. STUDY REGISTRATION Chinese Clinical Trial Registry (http://www.chictr.org.cn): ChiCTR1900020690.
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105
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Wu JQ, Mao LB, Wu J. Efficacy of exercise for improving functional outcomes for patients undergoing total hip arthroplasty: A meta-analysis. Medicine (Baltimore) 2019; 98:e14591. [PMID: 30855443 PMCID: PMC6417520 DOI: 10.1097/md.0000000000014591] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The objective of this meta-analysis was aimed to illustrate the functional outcomes of exercise for total hip arthroplasty (THA) patients. METHODS In July, 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on exercise for functional outcomes for THA patients were retrieved. The primary endpoint was walking speed. Other outcomes included physical activity scale, Harris hip score, pain scores, abduction strength, and the length of hospital stay. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. RESULTS Ten clinical studies with 441 patients were ultimately included in the meta-analysis. Compared with the control group, exercise was associated with an increase of the walking speed by 0.15 m/s than control group (weighted mean difference [WMD] 0.15; 95% confidence interval [CI] 0.08, 0.22; P = .000). Also, exercise group could also increase Harris hip score (WMD 8.49; 95% CI 5.19, 11.78; P = .000) and abduction strength than control group (WMD 9.75; 95% CI 5.33, 14.17; P = .000). What is more, exercise has a beneficial role in reducing the pain scores (WMD -1.32; 95% CI -2.07, -0.57; P = .001) and the length of hospital stay (WMD -0.68; 95% CI -1.07, -0.29; P = .001) than the control group. However, there was no significant difference between the physical activity scale (WMD -2.13; 95% CI -6.31, 2.05; P = .317). CONCLUSIONS Compared with control group in the management of THA, postoperative exercise has a better pain relief and clinical outcomes. Considering the beneficial of the postoperative exercise, we take a positive attitude toward use exercise for patients with THA.
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Affiliation(s)
| | | | - Jian Wu
- Institute Office, Jingjiang People's Hospital, Jingjiang, Taizhou, Jiangsu Province, China
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106
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Wu J, Li G, Chen Y, Deng J, Zhang C. [Comparison of combined intravenous and topical use of tranexamic acid with different dosage in primary total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 32:1397-1401. [PMID: 30417614 DOI: 10.7507/1002-1892.201805008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objective To compare the efficacy and safety of intra-articular combined with intravenous administration of tranexamic acid (TXA) with different dosage for reducing blood loss in primary total knee arthroplasty (TKA). Methods Between January 2017 and June 2017, 90 patients suffering from unilateral osteoarthritis who underwent primary TKA were randomly scheduled to three interventions, named groups A, B, and C. Single dosage of TXA via intravenous injection (IV) and different dosages of TXA via intra-articular injection (IA) were utilized in three groups, respectively. All patients in three groups received 1 g TXA IV at 10 minutes preoperatively, and received 1, 2, and 3 g TXA IA diluted in 50 mL saline after wound closure in groups A, B and C, respectively. The age, gender, body mass index, affected side of the knee, grade of osteoarthritis, grade of America Society of Anesthesiologist, preoperative hemoglobin (Hb) concentration, platelet count, preoperative prothrombin time, and activated partial thromboplastin time were not significantly different between groups ( P>0.05). The postoperative wound blood drainage, Hb concentration at 1, 3, and 7 days after operation, transfusion rate, and thromboembolic complications were observed. All patients were routinely observed for deep vein thrombosis (DVT) by the color Doppler ultrasonography at 1 week, 1 month, and 3 months after operation, and the symptomatic pulmonary embolism (PE) were observed. Results All patients in three groups were followed up 7-12 months (mean, 8.4 months). There was no significant difference in operation time between groups ( P>0.05). The postoperative wound blood drainage was significantly less in groups B and C than that in group A ( P<0.05), whereas no significant difference was found between group B and group C ( P>0.05). Incision skin necrosis occurred in 1 case of group B and fat liquefaction occurred in 1 case of group C. The other incisions of 3 groups healed by first intention. There was no significant difference in incision complication incidence between groups. The Hb concentration was significantly higher in groups B and C than that in group A at 1, 3, and 7 days after operation ( P<0.05). While between group B and group C, the significant difference of Hb concentration only existed at 1 day after operation ( P<0.05). The number of patients who got blood transfusion was significantly less in group B (4 cases, 13.3%) and group C (5 cases, 16.7%) than that in group A (9 cases, 30%) ( P< 0.05), but no significant difference was found between group B and group C ( P>0.05). The result of color Doppler ultrasonography showed that 1 case got DVT in the contralateral calf at 3 weeks in group B. And there was no symptomatic PE in 3 groups. Conclusion Combined administration of IV and IA TXA in a clinically relevant reduction in blood loss was effective and safe in primary TKA, and no thromboembolic complication was observed. The combination of 1 g IV with 2 g IA could be the optional choice.
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Affiliation(s)
- Jun Wu
- Department of Orthopaedics, Nantong Sixth People's Hospital, Nantong Jiangsu, 226011, P.R.China
| | | | - Yunsu Chen
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200233, P.R.China
| | - Jianhua Deng
- Department of Orthopaedics, Nantong Sixth People's Hospital, Nantong Jiangsu, 226011, P.R.China
| | - Changqing Zhang
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, Shanghai, 200233,
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107
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Yaghmour KM, Atkinson S, Chisari E, McDonnell SM, Khan W. Effectiveness and safety of tranexamic acid in total joint arthroplasty. J Perioper Pract 2019; 29:356-360. [PMID: 30650055 DOI: 10.1177/1750458919825812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Total joint arthroplasty is associated with significant blood loss, that could result in the need of blood transfusions. Several techniques are being utilised to limit the volume of blood loss, in order to avoid transfusion. In this review, we look at blood loss in total joint arthroplasty and the perioperative strategies to limit the loss of blood. With the use of tranexamic acid gaining popularity, we analyse the published literature on its use in patients undergoing total joint arthroplasty. We have found that published studies favour using tranexamic acid in total joint arthroplasty as a safe and effective method of reducing blood loss.
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Affiliation(s)
- Khaled M Yaghmour
- Division of Trauma & Orthopaedics Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Sam Atkinson
- Division of Trauma & Orthopaedics Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Emanuele Chisari
- Division of Trauma & Orthopaedics Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.,Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico, University of Catania, Catania, Italy
| | - Stephen M McDonnell
- Division of Trauma & Orthopaedics Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Wasim Khan
- Division of Trauma & Orthopaedics Surgery Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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