1
|
Ghorbani M, Sadrian SH, Ghaderpanah R, Neitzke CC, Chalmers BP, Esmaeilian S, Rahmanipour E, Parsa A. Tranexamic acid in total hip arthroplasty: An umbrella review on efficacy and safety. J Orthop 2024; 54:90-102. [PMID: 38560591 PMCID: PMC10978533 DOI: 10.1016/j.jor.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose This comprehensive review was conducted to assess the effects of tranexamic acid (TXA) on blood loss, venous thromboembolism (VTE) risk, and wound complications following total hip arthroplasty (THA). Additionally, it sought to evaluate the effects of various TXA dosages, modes of administration, and combinations with other antifibrinolytic drug. Methods In search of systematic reviews and meta-analyses on the use of TXA in THA patients, we searched extensively through databases including Scopus, the Cochrane Library, Embase, Medline, the Web of Science, PubMed, and Google Scholar. We discovered 23 meta-analyses covering 32,442 patients overall that fulfilled our study criteria, spanning the period from the creation of these databases until May 2023. Results This comprehensive review's meta-analyses, which together examined over 35,000 patients, repeatedly demonstrated how TXA administration during THA successfully lowers perioperative blood loss and the need for transfusions. TXA reduced total blood loss by an average of 151-370 ml, postoperative hemoglobin levels by 0.5-1.1 g/dL, and transfusion rates by 19-26% on average when compared to control groups. The information gathered did not indicate that using TXA significantly increased the risk of VTE or wound complications. When comparing different TXA doses, administration techniques, or its use in conjunction with other anti-fibrinolytic therapies, no discernible differences were found in terms of efficacy or safety outcomes. Conclusion The comprehensive review clearly indicates that TXA improves THA outcomes without increasing the risk of adverse events by lowering blood loss and the requirement for transfusions. This insightful information can help surgeons decide whether to use TXA during THA procedures.
Collapse
Affiliation(s)
- Mohammad Ghorbani
- Orthopedic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Hassan Sadrian
- Students Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rezvan Ghaderpanah
- Students Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Colin C. Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Brian P. Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Saeid Esmaeilian
- Department of Radiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Rahmanipour
- Immunology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Parsa
- Orthopedic Surgery Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
2
|
Huynh MNQ, Wong CR, McRae MC, Voineskos S, McRae MH. The Effects of Tranexamic Acid in Breast Surgery: A Systematic Review and Meta-Analysis. Plast Reconstr Surg 2023; 152:993e-1004e. [PMID: 36995174 DOI: 10.1097/prs.0000000000010479] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
BACKGROUND Tranexamic acid (TXA) is used in trauma and surgical settings. Its role in reducing postoperative blood loss in breast surgery remains unclear. The primary objective of this study was to determine the effect of TXA on postoperative blood loss in breast surgery. METHODS Searches of the PubMed, Ovid MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases were performed from inception to April 3, 2020. Inclusion criteria were any retrospective reviews, prospective cohort studies, and randomized controlled trials that administered TXA (topical or intravenously) in the context of breast surgery. Quality of studies were evaluated using the risk of bias in randomized trials tool and the risk of bias in nonrandomized studies of interventions tool. Data were pooled, and a meta-analysis was performed. RESULTS In total, seven studies were included, representing 1226 patients (TXA, 632 patients; control, 622 patients). TXA was administered as follows: topically (20 mL of 25 mg/mL TXA intraoperatively; n =258 patients), intravenously (1 to 3 g perioperatively; n = 743 patients), or both (1 to 3 g daily up to 5 days postoperatively; n = 253 patients). TXA administration reduced hematoma formation in breast surgery (risk ratio, 0.48; 95% CI, 0.32 to 0.73), with no effect on drain output (mean difference, -84.12 mL; 95% CI, -206.53 to 38.29 mL), seroma formation (risk ratio, 0.92; 95% CI, 0.60 to 1.40), or infection rates (risk ratio, 1.01; 95% CI, 0.46 to 2.21). No adverse effects were reported. CONCLUSION The use of TXA in breast surgery is a safe and effective modality with low-level evidence that it reduces hematoma rates without affecting seroma rates, postoperative drain output, or infection rates.
Collapse
Affiliation(s)
| | - Chloe R Wong
- Michael G. DeGroote School of Medicine, McMaster University
| | | | | | | |
Collapse
|
3
|
Zheng C, Ma J, Xu J, Wu L, Wu Y, Liu Y, Shen B. The optimal regimen, efficacy and safety of tranexamic acid and aminocaproic acid to reduce bleeding for patients after total hip arthroplasty: A systematic review and Bayesian network meta-analysis. Thromb Res 2023; 221:120-129. [PMID: 36527742 DOI: 10.1016/j.thromres.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/06/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We aimed to evaluate the optimal regimen, efficacy and safety of tranexamic acid (TXA) and aminocaproic acid (EACA) for patients after total hip arthroplasty (THA). METHODS The network meta-analysis was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. The outcomes were total blood loss, transfusion rates, hemoglobin (HB) drop, and risk for pulmonary embolism (PE) or deep vein thrombosis (DVT). Subgroup analyses were performed among most effective regimens to determine the influences of timing and number of doses. RESULTS A total of 56 eligible RCTs with different regimens were assessed. For reducing total blood loss, all high doses of TXA and EACA except high dose of intra-articular (IA) TXA, as well as medium dose of combination of intravenous and intra-articular (combined IV/IA) TXA were most effective. All high doses of TXA, as well as medium dose of combined IV/IA TXA did not show inferiority in reducing transfusion rates and HB drop compared with other regimens. No regimens showed higher risk for PE or DVT compared with placebo, and no statistical differences were seen among most effective regimens in subgroup analyses. CONCLUSIONS As effective as high doses of EACA and TXA, medium dose (20-40 mg/kg or 1.5-3.0 g) of combined IV/IA TXA was enough to control bleeding for patients after THA without increasing risk for PE/DVT. TXA was at least 5 times more potent than EACA. Timing and number of doses had few influences on blood conserving efficacy. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Che Zheng
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jun Ma
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Jiawen Xu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Liming Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuangang Wu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuan Liu
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bin Shen
- Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
| |
Collapse
|
4
|
Augustinus S, Mulders MAM, Gardenbroek TJ, Goslings JC. Tranexamic acid in hip hemiarthroplasty surgery: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 2022; 49:1247-1258. [DOI: 10.1007/s00068-022-02180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/16/2022] [Indexed: 12/15/2022]
|
5
|
Hislop S, Alsousou J, Chou D, Rawal J, Hull P, Carrothers A. Fix and replace: Simultaneous fracture fixation and hip replacement for acetabular fractures in older patients. Injury 2022; 53:4067-4071. [PMID: 36207155 DOI: 10.1016/j.injury.2022.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Displaced acetabular fractures in the elderly present significant treatment challenges. The 'fix and replace' concept involves open reduction and internal fixation of the acetabulum, providing bony stability to accept the press-fit of an acetabular cup, with a cemented femoral stem. This allows early mobilisation and the advantages this confers. This study of 57 patients treated with fix and replace describes our technique, outcomes, and survival analysis. METHODS A retrospective review of 57 'fix and replace' procedures in patients aged over 60 was performed. Data was collected on mechanism, fracture type, demographics, time to surgery, comorbidity index, complications, EQ-5D and Oxford hip scores (OHS). Radiographs were reviewed for fracture healing, implant loosening, cup migration, and heterotopic ossification. RESULTS 57 patients aged 60 to 95 had fix and replace surgery. The median ASA score was 3. The mean Charlson Index was 4.8. 45 patients had a low-energy fall, 6 had a road traffic accident, 3 fell off a bicycle, and 1 mechanism was unclear. The fracture patterns were anterior column posterior hemitransverse (67%), associated both columns (9%), posterior column (9%), posterior column and posterior wall (9%), and transverse (2%). The mean time to surgery was 8.4 days (0-14). 26 out of 57 (46%) received a blood transfusion. Mean length of stay was 17.6 days (7-86). The mean follow-up was 35.5 months. 4 dislocations were treated with closed reduction, whilst 1 required excision arthroplasty. 2 infections resolved with debridement, antibiotics, and implant retention (DAIR), whilst 1 required a two-stage revision. 1 acetabular component had migrated requiring revision. The median pre-injury OHS was 44 (26-48) compared to 37.3 (28-48) at 1 year. There were no deaths at 30-days, whilst at 1 year 7 patients had died. Kaplan Meier survival analysis showed mean survival was 1984.5 days. Implant survival was 90% at 1 year. CONCLUSION While fix and replace is conceptually attractive, this medically complex patient group requires considerable support peri‑ and post-operatively. Further studies are required to provide clinicians with more information to decide on how best to provide a holistic management strategy for such injuries in this frail patient cohort.
Collapse
Affiliation(s)
- Simon Hislop
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Joseph Alsousou
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Daud Chou
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jaikirty Rawal
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Peter Hull
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Andrew Carrothers
- Department of Trauma & Orthopaedic Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| |
Collapse
|
6
|
Nakamura M, Shimakawa T, Nakano S, Sato R, Kondo K, Goto H, Sugimine Y, Enishi T, Sairyo K. Effectiveness of Primary Total Hip Arthroplasty Combined with Intra-articular and Intravenous Tranexamic Acid: A Retrospective Analysis of Number of Doses and Dose Strength. Indian J Orthop 2022; 56:1234-1239. [PMID: 35813550 PMCID: PMC9232659 DOI: 10.1007/s43465-021-00595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 12/14/2021] [Indexed: 02/04/2023]
Abstract
Introduction Total hip arthroplasty is a very effective reconstructive surgery but is often associated with massive perioperative bleeding, which leads to anemia. Tranexamic acid (TXA) minimizes bleeding and the need for blood transfusion. However, no universal standard TXA dosing regimen has been established. The objectives of this study were (1) whether there was a difference in the amount of decrease in perioperative mean hemoglobin (Hb) level between a single topical administration of TXA and intravenous and topical combination administration, and we also investigated whether there was a difference in the amount of decrease in the perioperative mean Hb level due to the difference in the local dose of TXA. Methods We retrospectively reviewed 292 hips between June 2013 and October 2020. The decrease in Hb level (difference between the preoperative value and the 7-day postoperative value) was used to estimate total perioperative blood loss. The mean perioperative reduction in Hb was compared between hips that received intravenous TXA preoperatively and intra-articular TXA at wound closure (combination administration group) and those that received only intra-articular TXA (single dose group). It was also compared by different local doses of tranexamic acid. Results The mean reduction in Hb was significantly smaller in the combination administration group than in the single dose group. However, no significant difference was observed due to the difference in the local dose of TXA administered at the time of wound closure. Conclusion Reducing perioperative bleeding decreases the invasiveness of surgery, which is important from the perspective of medical safety.
Collapse
Affiliation(s)
- Masaru Nakamura
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Tateaki Shimakawa
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Shunji Nakano
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Ryosuke Sato
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Kenji Kondo
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Hitoshi Goto
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Yuto Sugimine
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Tetsuya Enishi
- Tokushima Municipal Hospital, 2-34 Kita-Josanjima, Tokushima, 770-0812 Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-5 Kuramoto, Tokushima, 770-8503 Japan
| |
Collapse
|
7
|
Juraj M, Jaroslav V, Gažová A, Žufková V, Kyselovič J, Šteňo B. Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty. Medicine (Baltimore) 2021; 100:e26565. [PMID: 34190197 PMCID: PMC8257841 DOI: 10.1097/md.0000000000026565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/11/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA). METHODS Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications. RESULTS Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA. CONCLUSIONS The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.
Collapse
Affiliation(s)
- Masaryk Juraj
- Orthopedic Department of the University Hospital Trencin, Legionárska 28, 911 71 Trenčín
| | - Vidan Jaroslav
- Orthopedic Department of the University Hospital Trencin, Legionárska 28, 911 71 Trenčín
| | - Andrea Gažová
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine Comenius University
| | - Viera Žufková
- Department of Languages, Faculty of Pharmacy, Comenius University
| | - Ján Kyselovič
- V. Department of Internal Medicine, Faculty of Medicine Comenius University, Bratislava, Slovakia
| | - Boris Šteňo
- II. Department of Orthopedics and Traumatology, University Hospital and Faculty of Medicine, Comenius University
| |
Collapse
|
8
|
Lucas B, Riebau C, Mohr J, Pliske G, Walcher F, Piatek S. Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture - a randomized clinical trial. BMC Musculoskelet Disord 2021; 22:113. [PMID: 33499843 PMCID: PMC7836593 DOI: 10.1186/s12891-021-03983-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. METHODS We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali's formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. RESULTS Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. CONCLUSIONS We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. TRIAL REGISTRATION DRKS, DRKS00017452 , Registered 11 June 2019 - Retrospectively registered.
Collapse
Affiliation(s)
- Benjamin Lucas
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany.
| | - Christian Riebau
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Juliane Mohr
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Gerald Pliske
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Felix Walcher
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| | - Stefan Piatek
- Department of Trauma Surgery, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, D-39120, Magdeburg, Germany
| |
Collapse
|
9
|
Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement? Microorganisms 2020; 8:microorganisms8050671. [PMID: 32384628 PMCID: PMC7285138 DOI: 10.3390/microorganisms8050671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 12/20/2022] Open
Abstract
The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.
Collapse
|
10
|
Xu X, Jiang J, Liu W, Li X, Lu H. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res 2019; 14:430. [PMID: 31829245 PMCID: PMC6907225 DOI: 10.1186/s13018-019-1497-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/27/2019] [Indexed: 01/28/2023] Open
Abstract
Background Tranexamic acid (TXA) is widely used to reduce blood loss and transfusion rates in total hip arthroplasty(THA). Thromboelastography, which can monitor coagulation changes from clotting to fibrinolysis dynamically. In this study, thromboelastography was used to assess the dynamic changes in the coagulation of patients who underwent THA with the administration of TXA. Methods This randomized controlled trial consisted of 207 consecutive patients who underwent primary total hip arthroplasty. Patients were randomized into three groups: topical-TXA group received a topical application of TXA, IV-TXA group received an intravenous injection of TXA, and control group. Thromboelastography was performed 1 day before surgery and first, fourth, seventh days after surgery. The primary outcomes were thromboelastography parameters, the rates of deep vein thrombosis(DVT), and pulmonary embolism(PE). Secondary outcomes included perioperative blood loss, transfusion rates, and other perioperative complications. Results The mean calculated total blood loss in the Topical-TXA group were 832.7 ± 279.84 ml and 834.8 ± 322.94 ml in the IV-TXA group, which were significantly reduced (p < 0.05) compared with control groups at 1093.3 ± 379.7 ml. There were no significant differences between topical-TXA and IV-TXA groups in total blood loss or transfusion rates. K and R have reached a nadir from preoperative levels to 4th day postoperatively and then began to increase.α angle and CI peaked from preoperative levels to the fourth day postoperatively and then began to decline.IV-TXA significantly (p < 0.05) promoted coagulation levels compared with topical-TXA and control groups in the early postoperative period. Almost no significant differences were observed between topical-TXA and control groups in thromboelastography parameters.No significant differences were observed in the incidence of thromboembolic complications and other perioperative complications. Conclusions The topical administration of TXA had the same hemostatic effect as intravenous injection tranexamic acid. Coagulation function peaked on 4th day postoperatively and then began to decline. IV-TXA was more enhanced coagulation functions compared with topical-TXA.
Collapse
Affiliation(s)
- Xingming Xu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.,Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Jiang Jiang
- Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Wei Liu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.,Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Xiaofeng Li
- Department of Orthopaedics, The First Affiliated Hospital Of Nanchang University, No. 17, Yongwaizheng Street, Nanchang, 330006, Jiangxi, China
| | - Huading Lu
- Department of Orthopaedic, The Fifth Affiliated Hospital Of Sun Yat-Sen University, No. 52, Meihua East Road, Zhuhai, 519000, Guangdong, China.
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|