A comparison of combined intravenous and topical administration of tranexamic acid with intravenous tranexamic acid alone for blood loss reduction after total hip arthroplasty: A meta-analysis

Liu, Xiangcheng; Liu, Jinglong; Sun, Ganghe

doi:10.1016/j.ijsu.2017.03.031

Cited by 47 publications

(32 citation statements)

References 27 publications

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“…However, they established that there was a difference in the amount of TXA between the topical (2 g) and IV (1 g) groups. Liu et al [50] in their meta-analysis study in patients after THA reported that the combined application of IV and topical TXA reduced the total blood loss compared with IV use alone. Moreover, they did not report an increased risk of complications.…”

Section: Comparison Between Local and IV Applicationmentioning

confidence: 99%

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Georgiev

Tanchev

Zheleva

et al. 2018

Journal of Orthopaedic Translation

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PurposeMany randomised controlled trials and meta-analysis studies have presented the efficacy of tranexamic acid (TXA) without an increase of complications. However, questions still remain about the type of administration, optimal dose and secondary outcomes of TXA in total hip arthroplasty and total knee arthroplasty. The aim of this review is to summarise the existing information in literature concerning the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use.MethodsA literature review containing 63 articles from the PubMed data starting from the first description of tranexamic acid until now was made in trying to present the existing information in a simple and effective way.ResultsTXA leads to statistically significant reduction of peri and postoperative bleeding and in that way decreases blood transfusion rates and the infection risk. Topical and intravenous (IV) use of TXA revealed similar results, with no increase of deep venous thrombosis. Therefore, topical TXA could be a reasonable alternative in patients with contraindications for IV application of TXA.ConclusionsBlood loss control with TXA, a synthetic analogue of the amino acid lysine, may be an excellent and safe alternative to allogeneic blood transfusion after total hip arthroplasty and total knee arthroplasty. Further studies are needed to establish the efficacy of combined IV and topical administration of TXA with regard to diminishing blood loss and reducing hospital stay.The Translational Potential of this ArticleThis review briefly presents the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use with regard to diminishing blood loss and reducing hospital stay for better therapeutic strategies in orthopaedics.

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Section: Comparison Between Local and IV Applicationmentioning

confidence: 99%

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Georgiev

Tanchev

Zheleva

et al. 2018

Journal of Orthopaedic Translation

View full text Add to dashboard Cite

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“…Tranexamic acid (TXA) is a synthetic antifibrinolytic agent that has been routinely administered in many surgical fields. [ 6 , 7 ] TXA has been used in TSA since 2015, and the efficacy of TXA in TSA has been debated. Friedman et al [ 8 ] determined that TXA could decrease the need for transfusion in TSA patients, while Gillespie et al [ 9 ] found that there was no significant difference between TXA and controls in terms of the need for transfusion.…”

Section: Introductionmentioning

confidence: 99%

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Wang

Yuan

et al. 2017

Medicine

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Background:The purpose of this meta-analysis is to compare the efficacy of tranexamic acid (TXA) versus placebo after a total shoulder arthroplasty (TSA).Methods:In April 2017, a systematic computer-based search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, and Google. Studies comparing TXA versus placebo in reducing blood loss after TSA were included. The endpoints were the need for transfusion, blood loss in drainage, hemoglobin drop, and total blood loss. Stata 12.0 software was used for the meta-analysis.Results:Six studies involving a total of 637 patients met the inclusion criteria. The meta-analysis revealed that, compared with control groups, treatment with TXA could decrease the need for transfusion (P < .00001), blood loss in drainage (P = .000), hemoglobin drop (P = .001), and total blood loss (P = .000).Conclusion:TXA can decrease the need for transfusion as well as total blood loss in TSA patients. There was a negative correlation between the TXA dose and the need for transfusion and blood loss in drainage. Because the administration route and the dose of TXA were different, more studies are needed in order to identify the optimal dose and route.

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“…However, the combined method of TXA has been widely used in TKA and THA. Current studies have confirmed that the combined regimen of intravenous infusion of TXA combined with intra‐articular local injection is superior to the single‐route regimen. Through a prospective study of 150 patients, Huang et al found that the combined regimen of TXA in TKA could reduce the overall effect of perioperative bleeding and even replace the role of the tourniquet.…”

Section: Discussionmentioning

confidence: 99%

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

Guo

et al. 2020

Orthopaedic Surgery

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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 AE 29.22 and 165.35 AE 43.08 mL (P < 0.05), respectively, and 327.17 AE 64.26 and 385.45 AE 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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A comparison of combined intravenous and topical administration of tranexamic acid with intravenous tranexamic acid alone for blood loss reduction after total hip arthroplasty: A meta-analysis

Cited by 47 publications

References 27 publications

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

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

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