Comparison Between Intravenous and Intra-articular Regimens of Tranexamic Acid in Reducing Blood Loss During Total Knee Arthroplasty

Soni, Ashwani; Saini, Raghav; Gulati, Anmol; Paul, Rajesh; Bhatty, Shiraj; Rajoli, Sreekanth Reddy

doi:10.1016/j.arth.2014.03.039

Cited by 90 publications

(92 citation statements)

References 29 publications

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“…2,3,5,6 TXA has been shown to be safe in patients with severe comorbidities 7 and to be beneficial regardless of preoperative haemoglobin (Hgb) value 8 in total joint arthroplasties. In respect of the single use of TXA, topical TXA has been reported to be safe 1,9,10 and as equally effective as the IV (intravenous) regimen 1,4,11 in TKA. However, the combined administration of TXA (IV þ topical) has been shown to more effective than the single regimen.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Recent randomized controlled trials (RCTs) have proved that tranexamic acid (TXA) reduces blood loss and transfusion rates after TKA, and TXA is routinely used in TKA following the publication of studies with excellent results. 2,3,5,6 TXA has been shown to be safe in patients with severe comorbidities 7 and to be beneficial regardless of preoperative haemoglobin (Hgb) value 8 in total joint arthroplasties.…”

Section: Introductionmentioning

confidence: 99%

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The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

Çankaya

Daşar

Satilmis

et al. 2017

J Orthop Surg (Hong Kong)

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Aims: The combined (IV (intravenous) þ topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral þ topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral þ topical use is as safe and efficient as the IV þ topical use, in addition to the main advantage of relatively low cost. Methods: In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral þ topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. Results: There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 (p < 0.05) in favour of the combined group. The post-operative drainage amounts (p ¼ 0.0001), measured blood loss volume (p ¼ 0.003) and transfusion rates (p ¼ 0.03) were lower in the combined (oral þ topical) group compared to the topical group. Conclusions: Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

Çankaya

Daşar

Satilmis

et al. 2017

J Orthop Surg (Hong Kong)

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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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“…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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Comparison Between Intravenous and Intra-articular Regimens of Tranexamic Acid in Reducing Blood Loss During Total Knee Arthroplasty

Cited by 90 publications

References 29 publications

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

Subgroup Analysis of Topical Tranexamic Acid in Total Knee Arthroplasty

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

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