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Electricwala AJ, Dasgupta R, Kulkarni S, Electricwala JT. A Comparison of Oral vs Intravenous Tranexamic Acid in Patients Undergoing Staggered Bilateral Total Knee Arthroplasty. THE ARCHIVES OF BONE AND JOINT SURGERY 2022; 10:261-266. [PMID: 35514760 PMCID: PMC9034799 DOI: 10.22038/abjs.2021.49561.2459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 08/03/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND All previous studies comparing the blood sparing efficacy oral and intravenous tranexamic acid (TXA) in total knee arthroplasty have involved two or more patient cohorts, outcomes of which may be limited by inter-individual variability in human drug response. The purpose of this study was to evaluate if both oral and intravenous preparations of TXA are equivalent at reducing blood loss in the same patients undergoing staggered bilateral total knee arthroplasty. METHODS 40 patients undergoing staggered bilateral total knee replacement were recruited. They received 2 g of oral TXA 2 hours preoperatively for the first knee and 1 g of bolus intravenous TXA 15 minutes before skin incision for the second knee. 7 patients were excluded for protocol deviation, leaving 33 participants for the study. The second knee was operated within 5-6 days of the first knee. The primary outcome was reduction in hemoglobin. Equivalence was tested with a two one-sided test (TOST) and a P < 0.05 indicated equivalence between oral and intravenous modes of TXA administration. RESULTS The mean reduction in hemoglobin was similar between oral and intravenous mode of TXA administration (2.18 and 2.16 g/dl respectively, P<0.0001, equivalence). There was no significant difference in the total hemoglobin loss and total red blood cell volume loss {(104 and 102 g, P=0.86) and (865 and 863 ml, P=0.53) respectively}. CONCLUSION Oral and intra venous TXA have equal blood sparing properties in patients undergoing staggered bilateral total knee arthroplasty.
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Affiliation(s)
| | - Rumi Dasgupta
- Essence Medical Centre, Westwinds, Westwinds Dr. NE, Calgary, Alberta, Canada
| | - Sameer Kulkarni
- Electricwala Hospital, Pleasant Park D Building, Pune, Maharashtra, India
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Li S, Lu Q, Guo X, Zhang M, Miao Z, Luo D, Liu P. Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case-Control Study. Orthop Surg 2020; 12:515-523. [PMID: 32162488 PMCID: PMC7189047 DOI: 10.1111/os.12652] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/07/2020] [Accepted: 02/07/2020] [Indexed: 12/11/2022] Open
Abstract
Objective To investigate whether intravenous combined with topical administration of tranexamic acid (TXA) is superior to intravenous administration alone in terms of blood loss, incision complications, functional recovery, and pain relief in high tibial osteotomy (HTO). Methods Clinical data of patients with knee osteoarthritis (OA) treated with unilateral HTO were retrospectively reviewed. The patients were grouped according to the TXA administration method, with 24 patients in the combined group and 21 in the solo group. In the combined group, 100 mL saline containing 1 g TXA was intravenously administered before application of a tourniquet, and 20 mL saline containing 2 g TXA was injected through a drainage tube after closure of the incision. Alternatively, 100 mL of saline containing 1 g TXA was intravenously administered before application of a tourniquet in the solo group. The blood loss and adverse events were compared between the two groups. Results All patients were followed for more than half a year. The drainage volume on the first day and total blood loss on the second day after surgery in the combined and single treatment groups were 130.06 ± 29.22 and 165.35 ± 43.08 mL (P < 0.05), respectively, and 327.17 ± 64.26 and 385.45 ± 63.31 mL (P < 0.05). There were no blood transfusions in either group. One case of delayed incision healing was observed in the solo group, and no such event occurred in the combined group. There were no significant differences between the two groups in terms of the following factors: the activated partial thromboplastin time (APTT) and prothrombin time (PT); levels of fibrinogen (FIB) and D‐dimer on the second day after surgery; numbers of hospitalization days and thromboembolism events; and knee joint function and visual analog score 6 months after surgery. Conclusion Intravenous combined with topical TXA administration in HTO is superior to intravenous administration alone for reducing postoperative blood loss and drainage volume without thromboembolic complications. However, even with only intravenous TXA administration, no cases of blood transfusion and only 1 case of incision complication occurred. At the same time, the combined use of TXA did not improve the recovery of knee joint function and pain relief after HTO.
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Affiliation(s)
- Songlin Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Qunshan Lu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Xingzhi Guo
- Department of Orthopedics, Boxing County Hospital of Traditional Chinese Medicine, Binzhou, China
| | - Meng Zhang
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Zhuang Miao
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Desu Luo
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
| | - Peilai Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Jinan, China
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Zhang R, Yang Z, Lei T, Ping Z, Bai G. Effects of aminocaproic acid on perioperative hidden blood loss in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation. J Int Med Res 2019; 47:5010-5018. [PMID: 31526169 PMCID: PMC6833433 DOI: 10.1177/0300060519872037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To determine the efficacy of aminocaproic acid on perioperative hidden blood loss (HBL) in elderly patients with femoral intertrochanteric fracture treated with proximal femoral nail anti-rotation (PFNA). Methods Seventy consecutively admitted elderly patients with femoral intertrochanteric fracture treated with PFNA between 1 May 2017 and 1 May 2018 were recruited. The patients were randomised into the experimental and control groups receiving 1 g aminocaproic acid in 200 mL saline and only 200 mL normal saline intravenously, respectively. The following factors were recorded: demographic characteristics, haemoglobin and haematocrit levels on preoperative day 1 and postoperative days 1 and 3, surgical blood loss, postoperative drainage, the rate and volume of transfusion, and complications. Results No significant differences were seen in surgical blood loss and postoperative drainage between the experimental and control groups, though total blood loss was greater in the control group. Visible blood loss and HBL were significantly lower in the experimental group than in the control group, and a lower rate and volume of transfusion were also recorded in the experimental group. Conclusion Aminocaproic acid significantly reduced perioperative HBL and volume and rate of transfusion in elderly patients with femoral intertrochanteric fracture receiving PFNA.
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Affiliation(s)
- Rui Zhang
- Department of Orthopaedics, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China.,Department of Orthopaedic Trauma, Hefei Orthopedic Hospital, Anhui Province, China
| | - Zhuqing Yang
- Department of Anesthesiology, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Tao Lei
- Department of Orthopaedics, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Zichuan Ping
- Department of Orthopaedics, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
| | - Guangchao Bai
- Department of Orthopaedics, Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, Zhejiang Province, China
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Clavé A, Gérard R, Lacroix J, Baynat C, Danguy des Déserts M, Gatineau F, Mottier D. A randomized, double-blind, placebo-controlled trial on the efficacy of tranexamic acid combined with rivaroxaban thromboprophylaxis in reducing blood loss after primary cementless total hip arthroplasty. Bone Joint J 2019; 101-B:207-212. [PMID: 30700116 DOI: 10.1302/0301-620x.101b2.bjj-2018-0898.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Cementless primary total hip arthroplasty (THA) is associated with risks of bleeding and thromboembolism. Anticoagulants are effective as venous thromboprophylaxis, but with an increased risk of bleeding. Tranexamic acid (TXA) is an efficient antifibrinolytic agent, but the mode and timing of its administration remain controversial. This study aimed to determine whether two intravenous (IV) TXA regimens (a three-hour two-dose (short-TXA) and 11-hour four-dose (long-TXA)) were more effective than placebo in reducing perioperative real blood loss (RBL, between baseline and day 3 postoperatively) in patients undergoing THA who receive rivaroxaban as thromboprophylaxis. The secondary aim was to assess the non-inferiority of the reduction of blood loss of the short protocol versus the long protocol. PATIENTS AND METHODS A multicentre, prospective, randomized, double-blind, placebo-controlled trial was undertaken involving 229 patients undergoing primary cementless THA using a posterior approach, whose extended rivaroxaban thromboprophylaxis started on the day of surgery. There were 98 male and 131 female patients, with a mean age of 65.5 years (32 to 91). The primary outcome, perioperative RBL, was evaluated at 72 hours postoperatively. The efficacy of short- and long-TXA protocols in the reduction of perioperative RBL was compared with a placebo group. RESULTS TXA significantly reduced perioperative blood loss compared with placebo (p < 0.001); the mean differences were 525.3 ml (short-TXA vs placebo) and 550.1 ml (long-TXA vs placebo). No venous or arterial thromboembolic complications were reported. The upper boundary of the 95% confidence interval, when comparing short and long protocols, was below the pre-specified margin of non-inferiority (p = 0.027). CONCLUSION In patients undergoing primary cementless THA, using a posterior approach, who are treated with rivaroxaban for thromboembolic prophylaxis, short- and long-TXA IV protocols are significantly more effective than placebo in reducing perioperative RBL, without any thromboembolic complications. Non-inferiority of a short- versus a long-TXA protocol in reducing perioperative RBL was supported in a secondary analysis.
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Affiliation(s)
- A Clavé
- Department of Orthopedics and Traumatology, Brest University Hospital, Brest, France
| | - R Gérard
- Department of Orthopedics and Traumatology, Polyclinique Keraudren, Brest, France
| | - J Lacroix
- Department of Orthopedics and Traumatology, Morlaix General Hospital, Morlaix, France
| | - C Baynat
- Department of Orthopedics and Traumatology, Clermont-Tonnerre Armed Forces Hospital, Brest, France
| | - M Danguy des Déserts
- Department of Anesthesiology, Clermont Tonnerre Military Hospital, Brest, France; Investigation Network on Venous Thromboembolism (F-Crin Network INNOVTE), Saint-Étienne, France
| | - F Gatineau
- Brest University Hospital, University of Western Brittany, Unité de recherche EA 3878 GETBO, Centre d'Investigation Clinique, and Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1412, Brest, France
| | - D Mottier
- Brest University Hospital, UBO, and EA 3878, CIC INSERM 1412, Brest, France; Investigation Network on Venous Thromboembolism (F-Crin Network INNOVTE), Saint-Étienne, France
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Sridharan K, Sivaramakrishnan G. Tranexamic acid in total hip arthroplasty: Mixed treatment comparisons of randomized controlled trials and cohort studies. J Orthop 2018; 15:81-88. [PMID: 29657445 DOI: 10.1016/j.jor.2018.01.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/14/2018] [Indexed: 01/08/2023] Open
Abstract
Background The present study is a network meta-analysis of various routes of tranexamic acid (TXA) in patients with total hip arthroplasty (THA). Methods Randomized controlled trials and cohort studies evaluating TXA in patients with THA were included. Number of patients requiring blood transfusion was the primary outcome. Results Pooled estimate for TXA use against placebo for blood transfusion rate was 0.30 [0.23, 0.39] favoring TXA. Maximum reduction in the risk of blood transfusion was observed with topical plus intra-operative intravenous TXA. Conclusion Combined topical and intravenous TXA during surgery may perform better than other modes in patients undergoing THA.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology and Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Gowri Sivaramakrishnan
- School of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
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Suurmond R, van Rhee H, Hak T. Introduction, comparison, and validation of Meta-Essentials: A free and simple tool for meta-analysis. Res Synth Methods 2017; 8:537-553. [PMID: 28801932 PMCID: PMC5725669 DOI: 10.1002/jrsm.1260] [Citation(s) in RCA: 427] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 07/14/2017] [Accepted: 07/24/2017] [Indexed: 01/02/2023]
Abstract
We present a new tool for meta-analysis, Meta-Essentials, which is free of charge and easy to use. In this paper, we introduce the tool and compare its features to other tools for meta-analysis. We also provide detailed information on the validation of the tool. Although free of charge and simple, Meta-Essentials automatically calculates effect sizes from a wide range of statistics and can be used for a wide range of meta-analysis applications, including subgroup analysis, moderator analysis, and publication bias analyses. The confidence interval of the overall effect is automatically based on the Knapp-Hartung adjustment of the DerSimonian-Laird estimator. However, more advanced meta-analysis methods such as meta-analytical structural equation modelling and meta-regression with multiple covariates are not available. In summary, Meta-Essentials may prove a valuable resource for meta-analysts, including researchers, teachers, and students.
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Affiliation(s)
- Robert Suurmond
- Rotterdam School of Management, Erasmus University, The Netherlands
| | - Henk van Rhee
- Rotterdam School of Management, Erasmus University, The Netherlands
| | - Tony Hak
- Rotterdam School of Management, Erasmus University, The Netherlands
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