Comparison of Cytotoxic Effects of Intra-Articular Use of Tranexamic Acid versus Epinephrine on Rat Cartilage

Sukur, Erhan; Küçükdurmaz, Fatih

doi:10.12659/msm.908560

Cited by 11 publications

(7 citation statements)

References 27 publications

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“…Although toxicity has been reported at TXA concentrations of >20 mg/ml ( Parker et al, 2018 ; Sukur and Kucukdurmaz, 2018 ; McLean et al, 2019 ; Mortazavi et al, 2020 ; Bolam et al, 2021 ; González Osuna et al, 2021 ; Ma et al, 2021 ; Touzopoulos et al, 2021 ), we decided to include a concentration of 50 mg/ml in our experiments in order to demonstrate that the synergistic effect was not dose-dependent. Using the standard visualization method, TXA 50 mg/ml reached higher fold reductions in gentamicin MIC 50 in S. epidermidis (6 vs. 4 with TXA 10 mg/ml), although the same fold reduction in gentamicin MIC 50 was observed for S. aureus (5 with TXA 10 and 50 mg/ml).…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid in Combination With Vancomycin or Gentamicin Has a Synergistic Effect Against Staphylococci

et al. 2022

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BackgroundTranexamic acid (TXA) is an antifibrinolytic agent applied in orthopedic surgery and has been proven to reduce post-surgery infection rates. We previously showed that TXA also had an additional direct antimicrobial effect against planktonic bacteria. Therefore, we aimed to evaluate whether it has a synergistic effect if in combination with antibiotics.Materials and MethodsThree ATCC and seven clinical strains of staphylococci were tested against serial dilutions of vancomycin and gentamicin alone and in combination with TXA at 10 and 50 mg/ml. The standardized microtiter plate method was used. Minimal inhibitory concentrations (MICs) were calculated by standard visualization of well turbidity (the lowest concentration at which complete absence of well bacterial growth was observed by the researcher) and using the automated method (the lowest concentration at which ≥80% reduction in well bacterial growth was measured using a spectrophotometer).ResultsTranexamic acid-10 mg/ml reduced the MIC of vancomycin and gentamicin with both the standard method (V: 1-fold dilution, G: 4-fold dilutions) and the automated turbidity method (vancomycin: 8-fold dilutions, gentamicin: 8-fold dilutions). TXA-50 mg/ml reduced the MIC of gentamicin with both the standard turbidity method (6-fold dilutions) and the automated turbidity method (1-fold dilutions). In contrast, for vancomycin, the MIC remained the same using the standard method, and only a 1-fold dilution was reduced using the automated method.ConclusionOurs was a proof-of-concept study in which we suggest that TXA may have a synergistic effect when combined with both vancomycin and gentamicin, especially at 10 mg/ml, which is the concentration generally used in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Tranexamic Acid in Combination With Vancomycin or Gentamicin Has a Synergistic Effect Against Staphylococci

et al. 2022

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“…Parker et al [15] described cytotoxicity in human chondrocytes and cartilage explant at a TXA concentration over 20 mg/mL at 12 h. Also, McLean et al [16] showed that TXA decreased chondrocytes viability at high concentrations (100 mg/mL), as well as at low concentrations (1 mg/mL) over a longer duration (24 h). On the other hand, Ambra et al [17] found that TXA did not increase cytotoxicity when treated with porcine cartilage explants with 0 mg/mL to 4 mg/mL of TXA up to 6 h. Sukur et al [18] also reported that TXA was less cytotoxic than EPN in an animal model at the doses typically used in irrigation solution. Based on these findings, we can speculate that TXA can be used in arthroscopic surgery as a safe agent at low concentrations.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Bayram

2021

Jt Dis Relat Surg

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Over the past decade, arthroscopic repair has been recognized as an important treatment option for rotator cuff tears. Sufficient visualization is of paramount importance for the arthroscopic repair to be efficiently and effectively performed. Intra-articular bleeding is one of the main factors which compromises the visual clarity in arthroscopic procedures. [1,2] Therefore, several hemostatic techniques, including hypotensive anesthesia, electrocauterization, and use of pressure-or flow-controlled pumps, are utilized to prevent intraoperative bleeding and to obtain sufficient visualization during the arthroscopic surgical procedures. [3][4][5] Recently, a number of clinical trials have supported the use of irrigation fluid with Objectives: This study aims to investigate whether there was a difference between epinephrine (EPN) and tranexamic acid (TXA) in providing visual clarity during arthroscopic rotator cuff tear repair.Patients and methods: This double-blind, prospective, randomized-controlled clinical study included a total of 90 patients (42 males, 48 females; mean age: 55.6±8.3 years; range, 18 to 69 years) in whom either EPN (EPN group, n=47) or TXA-diluted irrigation solutions (TXA group, n=43) were used during rotator cuff tear arthroscopy between December 2017 and November 2019. Arthroscopy was performed using irrigation fluid containing 0.33 mg of EPN per 1 L of saline in the EPN group and 0.42 mg of TXA per 1 L of saline in the TXA group. All procedures were performed by two specialized shoulder surgeons. Visual clarity (primary endpoint) was rated by the operating surgeon using the Visual Analog Scale (VAS) in the immediate postoperative period. Secondary endpoints included total operating time (TOT), potential thrombotic or thromboembolic side effects, mean arterial pressure (MAP), and total amount of irrigation fluid used.Results: There was no significant difference in the surgeon rated-VAS scores between the groups. The mean VAS score was 7.6±1.62 (range, 4 to 10) in the EPN group and 7.1±1.74 (range, 3 to 10) in the TXA group (p=0.59). No cardiac, thrombotic, or thromboembolic complications were observed in any of the groups. Conclusion:Adding TXA to the irrigation fluid during the arthroscopic rotator cuff repair may provide similar visual quality to the EPN, as measured by VAS.

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“…38,51,56,62 In addition to potential venous thromboembolic risk, there is some evidence to suggest that TXA can have deleterious effects on chondrocytes and tendons. 9,13,23,47,64,67 Four RCTs administered IV TXA in arthroscopic procedures; however, in 2 studies, Chiang et al 12 and Karaaslan et al 33 administered TXA via intra-articular injection during ACL reconstruction for the presumed benefit of delivering efficacious doses to a surgical site with a lower systemic plasma concentration than that in oral or IV form. 16,18,50 The study by Chiang et al has sparked critique by experts in arthroscopy, 22,32,42,60 who have highlighted the conflicting literature that exists in regard to the safety of topical TXA administration to the joint microenvironment in vivo.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

et al. 2021

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Background: Hemarthrosis after anterior cruciate ligament (ACL) reconstruction procedures can delay rehabilitation and have toxic effects on the cartilage and synovium. Tranexamic acid is widely used in adult reconstruction procedures; however, its use in ACL reconstruction is a novel topic of study. Purpose: To analyze the available literature on hemarthrosis, pain, functional outcomes, and complications after administration of tranexamic acid in ACL reconstruction procedures. Study Design: Meta-analysis. Methods: A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of ACL reconstruction procedures. The studied outcomes included postoperative joint drain output, hemarthrosis grade, visual analog scale scores for pain, range of motion, Lysholm score, postoperative rates of deep venous thrombosis, and pulmonary embolism. Outcomes were pooled to perform a meta-analysis. Results: Five prospective randomized controlled trials met inclusion criteria for analysis. Four studies administered intravenous tranexamic acid in bolus or infusion form before ACL reconstruction, while 2 studies administered tranexamic acid via intra-articular injection. Specifically, tranexamic acid was administered intravenously (preoperative 15-mg/kg bolus 10 minutes before tourniquet inflation with or without 10 mg/kg/h for 3 hours postoperatively) or intra-articularly (10 mL [100 mg/mL] intraoperatively), and 1 study consisted of tranexamic acid administration in combined intravenous and intra-articular forms (15-mg/kg bolus 10 minutes before tourniquet inflation and intra-articular 3 g 10 minutes before tourniquet deflation). Tranexamic acid use in ACL reconstruction cases resulted in a mean reduction of 61.5 mL in postoperative drain output at 24 hours (95% CI, –95.51 to −27.46; P = .0004), lower hemarthrosis grade ( P < .00001), improved Lysholm scores, and reduction in visual analog scale scores for pain (−1.96 points; 95% CI, −2.19 to −1.73; P < .00001) extending to postoperative week 6. Range of motion was improved in the immediate postoperative period, and the need for joint aspiration within 2 weeks was reduced ( P < .001). There was no difference in venous thromboembolic event rate between the experimental and control groups. Conclusion: The use of intravenous tranexamic acid in ACL reconstruction surgery results in reduced joint drain output and hemarthrosis and improved pain scores and range of motion in the initial postoperative period without increased complications or thromboembolic events.

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Comparison of Cytotoxic Effects of Intra-Articular Use of Tranexamic Acid versus Epinephrine on Rat Cartilage

Cited by 11 publications

References 27 publications

Tranexamic Acid in Combination With Vancomycin or Gentamicin Has a Synergistic Effect Against Staphylococci

Tranexamic Acid in Combination With Vancomycin or Gentamicin Has a Synergistic Effect Against Staphylococci

Comparison of the efficacy of irrigation with epinephrine or tranexamic acid on visual clarity during arthroscopic rotator cuff repair: A double-blind, randomized-controlled study

Tranexamic Acid in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis

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