Blood Sparing Efficacy of Oral Tranexamic Acid in Primary Total Knee Arthroplasty: A Randomized Controlled Trial

Lee, Qunn Jid; Ching, Wai Yee; Wong, Yiu Chung

doi:10.5792/ksrr.16.074

Cited by 35 publications

(45 citation statements)

References 29 publications

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“…Tranexamic acid is widely used to decrease postoperative transfusion and bleeding. The e cacy is well proved by various studies already [1,2,4]. Use of navigation is also known to decrease the transfusion and bleeding, but the e cacy has been controversial among physicians [5,7].…”

Section: Discussionmentioning

confidence: 99%

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The effects of navigation and tranexamic acid in reducing the need for blood transfusion after TKA

Song

Kim

Chae

et al. 2020

Preprint

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Background: We investigate the synergistic effect of the use of tranexamic acid and navigation in reducing the need for blood transfusion after total knee arthroplasty (TKA). Secondly, we compare the effects of navigation and tranexamic acid on blood transfusion reduction after TKA. Methods: Patients were divided into 3 groups and compared. Those who had manual TKA with the use of tranexamic acid were group 1 (N = 30), those who had navigated TKA without tranexamic acid were group 2 (N = 30), and those who had navigated TKA with tranexamic acid were group 3 (N = 30). Group 1 was studied prospectively, while group 2 and 3 were studied retrospectively. All operation was held by one operator. We measured the frequency of transfusion after the operation within the admission period. To compare the postoperative bleeding, drainage volume during two days after surgery was compared and analyzed. Results: Group 1 (Manual TKA with tranexamic acid) had 2 cases of transfusion (6.7%), while there were 9 cases in group 2 (Navigated TKA with no tranexamic acid) (30%), and 3 cases in group 3 (Navigated TKA with tranexamic acid) (10%). In Chi-square test, this difference was statistically significant. Average of 525.50 ± 194.91 ml of drainage was drained in two days after surgery in group 1 (Manual TKA with tranexamic acid), 611.60 ± 263.20 ml in group 2 (Navigated TKA with no tranexamic acid) and 411.42 ± 188.21 ml in group 3 (Navigated TKA with tranexamic acid). This difference was analyzed in one-way ANOVA which showed significantly different. The need for transfusion in group 2 (Navigated TKA with no tranexamic acid) was 5.86 times higher than that in group 1 (Manual TKA with tranexamic acid). The necessity of transfusion in the group 3 (Navigated TKA with tranexamic acid) was 0.199 times higher than that of the group 2 (Navigated TKA with no tranexamic acid). Conclusion: The combined use of navigation and tranexamic acid has no synergistic effect in reducing post TKA bleeding and the need for blood transfusion compared to tranexamic acid alone. And, use of tranexamic acid is more effective than navigation in reducing blood transfusions and blood loss after TKA.

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Section: Discussionmentioning

confidence: 99%

“…Transfusion of blood after total knee arthroplasty (TKA) has widely been known as one of the main causes of postoperative infection [1]. To prevent transfusion, operators use tourniquets or inject tranexamic acid or etc [1][2][3][4]. Use of tranexamic acid has been proved to decrease the necessity of transfusion after TKA.…”

mentioning

confidence: 99%

The effects of navigation and tranexamic acid in reducing the need for blood transfusion after TKA

Song

Kim

Chae

et al. 2020

Preprint

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“…TXA has been shown to decrease blood loss both intraoperatively and postoperatively following TKA and is of particular importance in the JW population who are unable to receive transfusions. 39,40 In our study, we performed a subgroup analysis to elucidate the role of TXA in the prevention of blood loss in our JW cohort. While there was no difference in TT and number of patients who received drains, we did note a significant difference in the total and operative Hgb drop.…”

Section: Discussionmentioning

confidence: 99%

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

et al. 2019

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Despite the evolution of blood management protocols, total knee arthroplasty (TKA) occasionally requires allogeneic blood transfusion. This poses a particular challenge for Jehovah's Witnesses (JW) who believe that the Bible strictly prohibits the use of blood products. The aim of this study was to compare JW and a matched-control cohort of non-JW candidates undergoing TKA to assess the safety using modern blood management protocols. Fifty-five JW patients (63 knees) who underwent TKA at our institution between 2005 and 2017 were matched to 63 non-JW patients (63 knees). Patient demographics, intraoperative details, and postoperative complications including in-hospital complications, revisions, and 90-day readmissions were collected and compared between the groups. Additionally, subgroup analysis was performed comparing JW patients who were administered tranexamic acid (TXA) between the two groups. Baseline demographics did not vary significantly between the study cohorts. The mean follow-up was 3.1 years in both the JW and non-JW cohorts. Postoperative complications, including in-hospital complications (7.9 vs. 4.8%; p = 0.47), revision TKA (1.6 vs. 1.6%; p = 1.00), and 90-day readmission (1.6 vs. 4.8%; p = 0.31) were not significantly different between the JW and non-JW groups. Subgroup analysis demonstrated JW patients who received TXA had a significantly lower decline in postoperative hemoglobin (Hgb) (8.6 vs. 14.0%; p < 0.01). At a follow-up of up to 12 years, JW patients who underwent TKA have outcomes equivalent to non-JW patients without the need for transfusion. Our findings support that surgeons are more likely to optimize JW patients preoperatively with iron and folate supplementation. Despite these variations in preoperative optimization efforts, no significant difference with regard to Hgb or hematocrit levels was demonstrated. Level of evidence is III, retrospective observational study.

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“…Hence, oral TXA shall be best administered 2–3 hr before the planned surgery. Recently, researchers have started evaluating the therapeutic role of oral TXA administered both in the pre‐operative and post‐operative periods but there is hardly any consensus on the appropriate oral regimen of TXA . Oral TXA has also been found to be cost‐effective with nearly four to seven times less expensive than the intravenous counterpart .…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta‐Analysis of Randomized, Controlled Trials and Cohort Studies

Sridharan

Sivaramakrishnan

2017

Basic Clin Pharma Tox

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Tranexamic acid (TXA) has been shown to be effective in patients with total knee arthroplasty (TKA) in clinical studies with no consensus with regard to the most appropriate route of administration. We conducted a network meta-analysis to compare the evidence available on efficacy and safety of TXA in TKA. Electronic databases were searched for randomized, clinical trials and cohort studies that evaluated TXA in TKA. Publication bias, risk of bias and inconsistencies were assessed. Direct and indirect comparisons were carried out for blood transfusion rate and incidence of thrombotic complications. Sensitivity analyses and grading of evidence were performed for key comparisons. A cumulative meta-analysis was conducted for comparisons that had a minimum of 10 included studies. A total of 19 studies with 8916 participants were pooled for this network meta-analysis. No inconsistencies and publication bias were observed. Low risk of bias was observed for the majority of the included studies. When compared to placebo, the pooled estimates for mixed treatment analyses favoured (in the order of higher ranking) the combined pre-operative oral and topical TXA, intra-operative intravenous TXA with topical TXA, pre-operative intravenous TXA, intra-operative and post-operative intravenous TXA, intra-operative intravenous bolus and topical TXA. Additionally, combined intravenous and topical TXA performed better than topical TXA alone. No significant changes were observed in the sensitivity analyses. No significant differences were observed in the risk of thrombotic complications between the interventions. TXA is efficacious and safe in patients with TKA. The combined topical and intra-operative intravenous TXA may perform better.

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Blood Sparing Efficacy of Oral Tranexamic Acid in Primary Total Knee Arthroplasty: A Randomized Controlled Trial

Cited by 35 publications

References 29 publications

The effects of navigation and tranexamic acid in reducing the need for blood transfusion after TKA

The effects of navigation and tranexamic acid in reducing the need for blood transfusion after TKA

Total Knee Arthroplasty Is Safe in Jehovah's Witness Patients—A 12-Year Perspective

Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta‐Analysis of Randomized, Controlled Trials and Cohort Studies

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