Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: A meta-analysis of randomized controlled and prospective cohort trials

Wang, Hao; Shen, Bin; Zeng, Yi

doi:10.1016/j.knee.2014.09.010

Cited by 114 publications

(101 citation statements)

References 26 publications

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“…The most common metrics include total blood loss, intra-operative blood loss, post operative blood loss, drain output, hemoglobin reduction, and transfusion rates. Meta analyses comparing studies that use the same metrics for efficacy have widely determined TXA use is superior to placebo controls, however such analyses are rarely, if ever, able to compare studies using the exact same dosing regimens and so their conclusions are typically broadly applicable to the use of TXA but do not delve into the optimal IV and or topical dosing strategies other than speculation [6,7,[29][30][31].…”

Section: And Topical Usementioning

confidence: 99%

“…In THA and TKA, the most notable complication reported in the literature is venous thromboembolism. The vast majority of orthopaedic TXA studies show no increase in the rate of venous thromboembolism events [29][30][31]43,44]. Nishihara, et al is the only study in the recently published literature known to the authors that demonstrated a significant increase in venous thromboembolic events after TXA administration in total joint arthroplasty [18].…”

Section: Oral Usementioning

confidence: 99%

See 1 more Smart Citation

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

Walterscheid¹,

O’Neill²,

Carmouche³

2017

Surg Rehabil

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Section: And Topical Usementioning

confidence: 99%

Section: Oral Usementioning

confidence: 99%

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

Walterscheid¹,

O’Neill²,

Carmouche³

2017

Surg Rehabil

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“…[25] The authors did not find any difference in the degree of postoperative blood loss, number of administered BTs and in the incidence of thromboembolic complications.…”

Section: Discussionmentioning

confidence: 85%

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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“…[5][6][7][8][9][10]12,13] The patients in this study received 2 g TA intraarticularly at the end of the surgery before the skin closure similar to the previous published papers [5,13] while the others did not receive any antifibrinolytics.…”

Section: Discussionmentioning

confidence: 91%

“…[4] Topical use of TA has been becoming popular recently as it has the advantages of being easy to administer, providing a maximum concentration at the bleeding site, and inducing partial microvascular hemostasis by stopping fibrin clot dissolution in the affected area. Some studies about topical administration of TA showed reliable evidence that it was effective in reducing total blood loss and blood transfusion rate compared with the placebo [5][6][7][8][9] and also intravenous (IV) administrations. Topical use of TA has been shown to reduce postoperative swelling, leading to improved wound healing, reduced pain, and more rapid rehabilitation.…”

mentioning

confidence: 99%

Other benefits of intra-articular injection of tranexamic acid in primary total knee arthroplasty apart from reducing blood transfusion rates

Aydın

Durgut

Erkoçak

et al. 2017

Eklem Hastalik Cerrahisi

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ÖZAmaç: Bu çalışmada total diz artroplastisi (TDA) hastalarında eklem içi tranekzamik asit (TA) uygulamasının drenlerdeki kan miktarına, kan transfüzyonu miktarına, hastanede kalış süresine ve toplam maliyete etkisi değerlendirildi. Hastalar ve yöntemler: Çalışmaya TDA cerrahisi uygulanan toplam 118 hasta dahil edildi (24 erkek, 94 kadın; ort. yaş 67.0; dağılım 52-81 yıl). Hastalar eklem kapsülünün kapatılmasının ardından eklem içi 2 g TA uygulanan 58 hasta (TA grubu; 10 erkek, 48 kadın ort. yaş 65.6; dağılım 55-80 yıl) ve herhangi bir eklem içi enjeksiyon uygulanmayan 60 hasta (TA'sız grup; 14 erkek, 46 kadın; ort. yaş 68.3; dağılım 52-81 yıl) olarak iki gruba ayrıldı. Her hastanın ameliyat öncesi ve sonrası hemoglobin düzeyleri arasındaki maksimum farklılık, drenlerdeki kan miktarı, kan transfüzyonu miktarı, hastanede kalış süresi ve maliyeti kaydedildi. Bulgular: Ameliyat öncesi ve sonrası hemoglobin düzeylerindeki ortalama farklılık TA'sız grupta daha yüksek idi (1.7 g/dL'ye karşın 2.6 g/dL, p<0.05). Drenlerdeki ortalama kan miktarları (327.5 mL'ye karşın 800.0 mL, p<0.05), kan transfüzyonu miktarları (0 üniteye karşın 10 ünite, p<0.05), ortalama hastanede kalış süreleri (4.03 güne karşın 4.53 gün, p<0.05) ve hastane maliyetleri (1.935,26 Amerika Birleşik Devletleri dolarına karşın 1.959,64 Amerika Birleşik Devletleri doları, p<0.05) TA grubunda daha düşük idi. Sonuç: Primer TDA sırasında eklem içi TA uygulaması kan kaybını ve kan transfüzyonu gereksinimini azaltırken ameliyat sonrası hastanede kalış sürelerini kısaltıp toplam hastane maliyetlerini anlamlı şekilde azaltabilmektedir.Anahtar sözcükler: Kan kaybı; hastane maliyeti; total diz artroplastisi; tranekzamik asit. ABSTRACT Objectives:This study aims to evaluate the effect of intraarticular tranexamic acid (TA) administration on the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and the total cost in total knee arthroplasty (TKA) patients. Patients and methods:The study included a total of 118 patients (24 males, 94 females; mean age 67.0 years, range 52 to 81 years) who underwent primary unilateral TKA surgery. Patients were divided into two groups as 58 patients who were performed intra-articular injection of 2 g TA after closure of articular capsule (TA group; 10 males, 48 females, mean age 65.6 years; range 55 to 80 years) and 60 patients who were not performed any intra-articular injection (non-TA group; 14 males, 46 females; mean age 68.3 years; range 52 to 81 years). The maximum difference between pre-and postoperative hemoglobin levels, the amount of blood in the drains, the amount of blood transfusion, length of hospital stay, and cost of each patient were recorded. Results: The mean difference between pre-and postoperative hemoglobin levels were higher in the non-TA group (1.7 g/dL vs 2.6 g/dL, p<0.05). The mean amounts of blood in drains (327.5 mL vs 800.0 mL, p<0.05), the amounts of blood transfusions (0 units vs 10 units, p<0.05), the mean lengths of hospital stay (4.03 days vs 4.53 days, p<0.05), ...

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Comparison of topical versus intravenous tranexamic acid in primary total knee arthroplasty: A meta-analysis of randomized controlled and prospective cohort trials

Cited by 114 publications

References 26 publications

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

Tranexamic acid in adult elective orthopaedic and complex spinal surgery: A review

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

Other benefits of intra-articular injection of tranexamic acid in primary total knee arthroplasty apart from reducing blood transfusion rates

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