Comparison of Oral and Intravenous Tranexamic Acid for Prevention of Perioperative Blood Loss in Total Knee and Total Hip Arthroplasty

Gortemoller, Mary Alice; Allen, B.R.; Forsyth, Rochelle; Theiss, Kimberly; Cunningham, Kristal; Tucker, Calvin

doi:10.1177/1060028017735859

Cited by 16 publications

(28 citation statements)

References 6 publications

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“…No gray paper was included. Finally, 4 RCTs [ 10 – 13 ] and 2 non-RCT [ 14 , 15 ] which published from 2004 to 2017 were included in our study and includes 621 participates in the TXA groups and 2963 patients in the control groups. The search process was performed as presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…All studies [ 10 – 15 ] provided the total blood loss after TJAs. No significant statistical heterogeneity was found ( χ 2 = 1.03, df = 5, I 2 = 0.0%, P = .960) and a fixed-effects model was adopted.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies [ 10 – 15 ] showed the postoperative hemoglobin decline after TJA. There was no significant heterogeneity ( χ 2 = 0.25, df = 5, I 2 = 0.0%, P = .998).…”

Section: Resultsmentioning

confidence: 99%

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The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Wang

Zhao

et al. 2018

Medicine

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Background:Blood management after arthroplasties has become a serious problem. The objective is to perform a meta-analysis to compare the efficacy and safety between oral tranexamic acid (TXA) and intravenous TXA for blood management in total knee and hip arthroplasty.Methods:We systematically searched randomized controlled trials (RCTs) from Medline, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science and Google scholar. Eligibility criteria: Patients: adult patients with end-stage joint osteoarthritis, rheumatoid arthritis, and osteonecrosis of the femoral head, who prepared for TJA; Interventions: The experiential group received the intravenous form of TXA; Comparisons: Oral form of TXA; Outcomes: Total blood loss, hemoglobin reduction, transfusion requirements, duration of hospitalization, and thrombotic complications including deep vein thrombosis (DVT) and pulmonary embolism (PE); Study design: Randomized control trials (RCTs) and non-RCT. Meta-analysis results were collected and analyzed by the software STATA 11.0. After testing for heterogeneity between studies, data were aggregated for random-effects models when necessary.Results:Four RCTs and 2 non-RCTs were included in the meta-analysis. The present meta-analysis revealed that there were no significant differences regarding total blood loss (WMD = −25.013, 95% CI: −51.002 to 0.977, P = .059), postoperative hemoglobin decline (WMD = −0.090, 95% CI: −0.205 to 0.024, P = .122), or transfusion rate (RD = −0.039, 95% CI: −0.080 to 0.002, P = .062) between the 2 groups.Conclusion:Oral TXA shows comparable efficacy to that of the intravenous forms after total knee and hip arthroplasty. Due to the limited quality of evidence currently available, higher quality RCTs is necessary.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Wang

Zhao

et al. 2018

Medicine

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“…[30] Tranexamic acid has been shown to decrease intra-operative blood loss and the need for overall blood transfusion in knee and hip arthroplasties, and its efficacy and safety has been evaluated in a metaanalysis. [31][32][33] However, pre-operative anemia remains a risk-factor for blood transfusion despite tranexamic acid administration, and attempts to minimize post-operative Hb decrease have not been sufficient to compensate for low pre-operative Hb. [34] Furthermore, pre-operative blood transfusion remains controversial, with reports of multiple complication associated with pre-operative blood transfusion in hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty

Kijima¹,

Kayama

Saito³

et al. 2020

Preprint

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Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, intra-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%. Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics have an increased risk for post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

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“…[33] Tranexamic acid has been shown to decrease intra-operative blood loss and the need for overall blood transfusion in knee and hip arthroplasties, and its efficacy and safety has been evaluated in a metaanalysis. [34][35][36] However, pre-operative anemia remains a risk-factor for blood transfusion despite tranexamic acid administration, and attempts to minimize post-operative Hb decrease have not been sufficient to compensate for low pre-operative Hb. [37] Furthermore, pre-operative blood transfusion remains controversial, with reports of multiple complication associated with pre-operative blood transfusion in hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty.

Kijima¹,

Kayama

Saito³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Delirium is a well-known complication following surgery, especially with the increasing age of patients undergoing surgery. The increasing demands resulting from a prolonged healthy life expectancy has resulted in more arthroplasties despite their age and existing comorbidities. The purpose of this study is to explore the various risk factors that may contribute to delirium in unilateral and bilateral total knee arthroplasties in the elderly population. Methods: 170 patients who underwent unilateral or bilateral total knee arthroplasties were analyzed retrospectively for delirium. Age, sex, comorbidities, use of sedative-hypnotics, peri-operative blood loss, pre- and post-operative laboratory blood test results were investigated and analyzed. Results: The incidence of post-operative delirium was 6.5% (11 out of 170 patients) with a mean age of 79.5 (± 6.9) years, compared to 73.0 (± 9.0) years in the non-delirium group. Higher age, use of sedative-hypnotics, low pre-operative Hb and Ht, low post-operative Hb, Ht and BUN were observed in the delirium group. Multivariate logistic regression analysis identified that the use of sedative-hypnotics and pre-operative Hb level were independent risk factors for post-operative delirium after TKA. The odds ratios for the use of sedative-hypnotics and pre-operative Hb level were 4.6 and 0.53, respectively. Receiver operating characteristic curve analysis showed that pre-operative Hb of less than 11.1 g/dL was a predictor for the development of delirium, with a sensitivity of 54.6% and a specificity of 91.6%.Conclusion: Patients with a pre-operative Hb level of <11.1 g/dL or those using sedative-hypnotics are associated with post-operative delirium. Peri-operative management and preventative measures are therefore needed to reduce the risks of post-operative delirium in such patients.

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Comparison of Oral and Intravenous Tranexamic Acid for Prevention of Perioperative Blood Loss in Total Knee and Total Hip Arthroplasty

Abstract: This study provides evidence that oral TA is a clinically effective and cost-efficient alternative to IV TA in the setting of THA and TKA.

Cited by 16 publications

References 6 publications

The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty

Pre-operative hemoglobin level and use of sedative-hypnotics are independent risk factors for post-operative delirium following total knee arthroplasty.

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