A Prospective Double-Blind Placebo Controlled Trial of Topical Tranexamic Acid in Total Knee Arthroplasty

Georgiadis, Andrew; Muh, Stephanie J.; Silverton, Craig D.; Weir, Robb M.; Laker, Michael W.

doi:10.1016/j.arth.2013.03.038

Cited by 140 publications

(110 citation statements)

References 31 publications

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“…Topical or intraarticular tranexamic acid (TXA) has garnered recent attention for its ability to reduce transfusion rates [1,2,3,4] reduce length of stay [5], and reduce cost [1,6,7] following total joint arthroplasty. Our institution has seen and reported similar results [8].…”

Section: Introductionmentioning

confidence: 99%

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty

Tuttle¹,

Anazonwu²,

Rubin³

2014

JISRF

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Evidence continues to accumulate for the efficacy of tranexamic acid (TXA) use in primary total knee arthroplasty (TKA). An essential question that remains is to determine which specific subgroups of patients undergoing TKA will benefit from TXA use and if surgeons should be more selective in its administration. We performed a retrospective cohort study involving 187 TKA patients who received intraarticular ("topical") TXA, and compared these to 168 historical controls who did not receive TXA. These patients were then subdivided into groups based on gender, age, BMI, and preoperative hemoglobin for analysis. All patients, despite their demographics, saw an improvement in primary outcome measures without a detectable increase in complications. Based on these data, there are no restrictions on the use of TXA. Obese patients, females, and those over 65 years of age undergoing total knee arthroplasty may benefit from TXA most consistently.

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Section: Introductionmentioning

confidence: 99%

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty

Tuttle¹,

Anazonwu²,

Rubin³

2014

JISRF

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“…TXA has been shown to reduce blood loss and transfusion use in many surgical fields and seems safe to use [3,4,6,9,13,16]. To our knowledge, no previous studies have evaluated the use of TXA in conjunction with PAO.…”

Section: Discussionmentioning

confidence: 98%

“…Antifibrinolytic agents such as tranexamic acid (TXA) have shown safety and efficacy in reducing blood loss associated with various surgical procedures [3,4,6,9,13,16]. TXA inhibits fibrinolysis by reversibly binding to …”

Section: Introductionmentioning

confidence: 99%

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Wingerter

Keith

Schoenecker

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Tranexamic acid (TXA) has shown safety and efficacy in reducing blood loss associated with various surgical procedures. However, to our knowledge there are no studies evaluating the effect of TXA on blood loss and transfusion requirements associated with periacetabular osteotomy (PAO). Questions/purposes The main purpose of this study is to determine whether TXA reduces blood loss and transfusion use in patients undergoing PAO for symptomatic acetabular dysplasia. Our secondary purpose was to compare the frequency of symptomatic thromboembolic events between patients undergoing surgery with and without TXA. Methods A consecutive series of 100 periacetabular osteotomies performed by one surgeon was reviewed to compare the groups immediately before and after implementation of routine use of tranexamic acid (two retrospective cohorts). TXA dosing followed an established protocol with a standard dose of 1 g infused intravenously during 10 minutes before skin incision and an additional 1 g intravenously at wound closure. Outcome measures include total estimated blood loss perioperatively and transfusion requirements. Total estimated blood loss was calculated using a formula built from the National Surgical Quality Improvement Program data regarding surgical blood loss. Results The mean perioperative total estimated blood loss was less in the patients receiving TXA compared with blood loss in patients who did not receive TXA (706 mL versus 1021 mL; p \ 0.001; 95% CI, À495 to À134). Twenty-six (52%) of the 50 patients who did not receive TXA had postoperative blood transfusions compared with 15 (30%) of 50 who received TXA (odds ratio, 0.395; 95% CI, p = 0.0414). No symptomatic deep vein thromboses or symptomatic pulmonary emboli were identified in either group. Conclusions TXA reduces estimated blood loss and the frequency of transfusions in patients undergoing PAO for treatment of symptomatic acetabular dysplasia. Future prospective studies should confirm our findings to determine whether patients undergoing PAO should receive routine perioperative TXA. Level of Evidence Level III, therapeutic study.

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“…The dosage of TA was derived on the basis of protocols presented by published reports evaluating the efficacy of TA in the reduction of blood losses following total knee replacement. [8][9][10][11] All operations were performed under spinal anesthesia, using the same surgical technique (midline skin incision, medial parapatellar capsulotomy). Tourniquet was used only during cementing.…”

Section: Methodsmentioning

confidence: 99%

Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement

Lacko¹

2017

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada primer tek taraflı çimentolu total diz ameliyatı sırasında kan kaybını ve ameliyat sonrası erken komplikasyonların derecesini azaltmada intraartiküler traneksamik asit (TA) ve intravenöz (İV) TA'nın etkinliği ve güvenilirliği karşılaştırıldı. Hastalar ve yöntemler: Bu prospektif randomize çalışmaya diz osteoartriti olup tek taraflı çimentolu total diz replasmanı ameliyatı geçiren 90 hasta (36 erkek, 54 kadın; ort. yaş 68,7 yıl; dağılım 47-82 yıl) dahil edildi. Hastalar üç gruba randomize edildi: grup 1'e ameliyattan 20 dakika önce ve ilk dozdan üç saat sonra İV yolla TA (doz 10 mg/kg) verildi, grup 2'ye cerrahi alana lokal olarak (intraartiküler) TA (doz 3 g) verildi ve grup 3'e TA verilmedi. Ameliyat sırasındaki kan kaybı, ameliyat sonrası 24 saatte boşaltılan kan miktarı, toplam kan kaybı, hemoglobin ve hematokrit düzeylerindeki azalma ve kan transfüzyonu miktarı ölçüldü. Bulgular: Hastaların ameliyat öncesi demografik verilerinde gruplar arasında farklılık yoktu. Traneksamik asitin lokal veya İV uygulaması kan transfüzyonu sayısını ve drenajdaki kan kaybını anlamlı şekilde azalttı. Traneksamik asitin İV uygulaması istatistiksel olarak anlamlı daha yüksek hemoglobin ve hematokrit düzeyleri ve daha düşük ameliyat sonrası toplam kan kaybı ile ilişkiliydi. Grupların hiçbirinde ciddi komplikasyon gözlemlenmedi. Sonuç: Kan transfüzyonu sayısını azaltmada intraartiküler TA İV rejim kadar etkili idi. Ancak TA'nın İV uygulaması daha düşük toplam kan kaybı ile ilişkiliydi. Bulgularımız total diz replasmanı sırasında TA'nın İV uygulamasının intraartiküler uygulamaya göre daha üstün olduğunu gösterdi.Anahtar sözcükler: Artroplasti; diz; replasman; traneksamik asit. ABSTRACT Objectives:This study aims to compare the efficacy and safety of intra-articular tranexamic acid (TA) versus intravenous (IV) TA in the reduction of perioperative blood loss and the degree of early postoperative complications associated with primary unilateral cemented total knee replacement. Patients and methods: This prospective randomized study included 90 patients (36 males, 54 females; mean age 68.7 years; range 47 to 82 years) with knee osteoarthritis undergoing a unilateral cemented total knee replacement. Patients were randomized into three groups: group 1 received TA intravenously (dose 10 mg/kg) 20 minutes preoperatively and three hours after first dose, group 2 received TA (dose 3 g) locally (intra-articular) into surgical site, and group 3 did not receive TA. We measured perioperative blood loss, volume of drained blood in 24 hours postoperatively, overall blood loss, decrease in hemoglobin and hematocrit levels, and amount of blood transfusion. Results: There were no differences between the groups in terms of patient preoperative demographics. Local or IV administration of TA significantly reduced the number of blood transfusions and blood losses in drainage. Intravenous application of TA was associated with statistically significantly higher hemoglobin and hematocrit levels and lower overall postoperative blood losse...

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A Prospective Double-Blind Placebo Controlled Trial of Topical Tranexamic Acid in Total Knee Arthroplasty

Cited by 140 publications

References 31 publications

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty

Does Tranexamic Acid Reduce Blood Loss and Transfusion Requirements Associated With the Periacetabular Osteotomy?

Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement

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