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Xie J, Huang Q, Huang Z, Wang F, Liu J, Tian H, Huang W, Pei F. High dose of tranexamic acid infusion in primary total knee arthroplasty: A randomized multicenter clinical trail. Chin Med J (Engl) 2024; 137:359-361. [PMID: 38214305 PMCID: PMC10836875 DOI: 10.1097/cm9.0000000000002952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Indexed: 01/13/2024] Open
Affiliation(s)
- Jinwei Xie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Zeyu Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Fei Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei 050051, China
| | - Jun Liu
- Department of Orthopaedic Surgery, Tianjin Hospital, Tianjin 300211, China
| | - Hua Tian
- Department of Orthopaedic Surgery, Peking University Third Hospital, Haidian District, Beijing 100191, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Yuzhong District, Chongqing 400016, China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Jiang W, Wang X, Xu H, Liu M, Xie J, Huang Q, Zhou R, Zhou Z, Pei F. Tourniquets can further reduce perioperative blood loss in patients on dexamethasone and tranexamic acid during cemented total knee arthritis: a single-center, double-blind, randomized controlled trial. J Orthop Traumatol 2023; 24:17. [PMID: 37119309 PMCID: PMC10148759 DOI: 10.1186/s10195-023-00698-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 04/02/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND Multiple doses of dexamethasone and tranexamic acid can inhibit postoperative inflammation and reduce fibrinolysis and perioperative blood loss in total knee arthroplasty. In this single-center, double-blind, randomized clinical trial, the aim was to investigate whether applying a tourniquet to patients on dexamethasone and tranexamic acid could further reduce perioperative blood loss. MATERIALS AND METHODS Patients who underwent cemented total knee arthroplasty at our hospital were randomized to receive a tourniquet (n = 71) or not (n = 70) during the procedure. All patients received multiple doses of dexamethasone and tranexamic acid perioperatively. The primary outcome was perioperative blood loss, while secondary outcomes were surgery duration, postoperative laboratory indices of inflammation and fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, and complications. RESULTS Using a tourniquet was associated with significantly lower intraoperative blood loss (P < 0.001) and total blood loss (P = 0.007) as well as significantly shorter surgery duration (P < 0.001). In contrast, the tourniquet did not significantly affect hidden blood loss, postoperative inflammation or fibrinolysis, range of knee motion, VAS pain score, knee circumference, knee swelling rate, homologous transfusion, albumin use, or complications. CONCLUSIONS The results of this randomized clinical trial demonstrate that applying a tourniquet during cemented total knee arthroplasty to patients receiving multiple doses of dexamethasone and tranexamic acid can further reduce perioperative blood loss without increasing the risk of inflammation, fibrinolysis, or other complications. Thus, it is advised to use tourniquets combined with dexamethasone and tranexamic acid to reduce perioperative blood loss and avoid tourniquet-related adverse events. LEVEL OF EVIDENCE Therapeutic Level I. Trial registration Chinese Clinical Trail Registry, ChiCTR2200060567. Registered 5 June 2022-retrospectively registered, http://www.chictr.org.cn/showproj.aspx?proj=171291.
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Affiliation(s)
- Wenyu Jiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xing Wang
- Department of Orthopaedics, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Menghan Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinwei Xie
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Ronghua Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, No.37, Guoxue Road, Wuhou District, Chengdu, 610041, Sichuan, People's Republic of China
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Lei Y, Xie J, Huang Q, Pei F. Is there a maximal effect of tranexamic acid in patients undergoing total knee arthroplasty? A randomized controlled trial. MedComm (Beijing) 2020; 1:219-227. [PMID: 34766120 PMCID: PMC8491189 DOI: 10.1002/mco2.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/07/2020] [Accepted: 07/16/2020] [Indexed: 02/05/2023] Open
Abstract
The optimal dosing regimen of tranexamic acid (TXA) has not been determined in total knee arthroplasty (TKA). In this study, patients were randomized to receive a high initial‐dose (60 mg/kg) TXA before incision, followed by five doses 3, 6, 12, 18, and 24 hours later (A), or three doses 3, 12, and 24 hours later (B), or a single dose 3 hours later (C). The primary outcome was perioperative blood loss. Other outcomes such as, hemoglobin level, transfusion, the levels of fibrin (ogen) degradation products (FDP), D‐dimer, C‐reactive protein (CRP) and interleukin‐6 (IL‐6), coagulation parameters, and adverse events were also compared. The results showed that individuals in Groups A and B had reduced total and hidden blood loss (HBL), lower FDP, D‐dimer, CRP, and IL‐6 levels than in Group C. Such differences were also detected in HBL between Groups A and B. No differences were observed in other outcomes between Groups A and B. No differences were observed in coagulation parameters and adverse events among the three groups. In conclusion, a high initial‐dose (60 mg/kg) TXA before TKA followed by three doses can be sufficient to achieve maximal effects on total blood loss, fibrinolysis, and inflammation.
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Affiliation(s)
- Yiting Lei
- Department of Orthopedics The First Affiliated Hospital of Chongqing Medical University Chongqing People's Republic of China.,Department of Orthopedics West China Hospital Sichuan University Chengdu People's Republic of China
| | - Jinwei Xie
- Department of Orthopedics West China Hospital Sichuan University Chengdu People's Republic of China
| | - Qiang Huang
- Department of Orthopedics West China Hospital Sichuan University Chengdu People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics West China Hospital Sichuan University Chengdu People's Republic of China
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