Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?

Kim, Young Hoo; Park, Jang Won; Kim, Jun Shik; Seo, Dong Hyuk

doi:10.1007/s00402-017-2791-y

Cited by 22 publications

(18 citation statements)

References 24 publications

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“…Despite the safety and tolerance of tranexamic acid, the risk of thromboembolic phenomena has traditionally caused concerns about its use; however, recent studies have suggested that tranexamic acid does not significantly increase the risk of thromboembolism compared to untreated controls. 31,32 In our meta-analysis, this agent did not induce thromboembolism at all. The coagulation profiles in the treatment group did not differ from those in the control group, which supports the incidence results in our study and is similar with previous results.…”

Section: Discussionmentioning

confidence: 58%

“…The coagulation profiles in the treatment group did not differ from those in the control group, which supports the incidence results in our study and is similar with previous results. 32 The previous studies found a possible association between very high or prolonged doses of tranexamic acid and thromboembolic accidents, 33 but pre-or perioperative administration with a bolus dose between 10 and 20 mg/kg can be used safely. 31,32 In this study, we used I 2 to measure the degree of heterogeneity among studies.…”

Section: Discussionmentioning

confidence: 99%

“…32 The previous studies found a possible association between very high or prolonged doses of tranexamic acid and thromboembolic accidents, 33 but pre-or perioperative administration with a bolus dose between 10 and 20 mg/kg can be used safely. 31,32 In this study, we used I 2 to measure the degree of heterogeneity among studies. As a result, our study showed that there was no significant interstudy heterogeneity (I 2 < 50) in the most of outcomes except for partial thromboplastin time.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Kim

Kang

et al. 2018

The Laryngoscope

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Objectives Tranexamic acid might help control bleeding during surgery because of antifibrinolytic characteristics. We aimed to evaluate the effectiveness of systemic tranexamic acid compared to control in blood loss, operative time, and surgical field and incidence of postoperative emesis and thromboembolism in endoscopic sinus surgery. Methods Two authors independently searched six databases (PubMed, SCOPUS, Embase, the Web of Science, Google Scholar, and the Cochrane database) from their inception to July 2018. The included studies compared perioperative tranexamic acid administration (treatment group) with a placebo, and the outcomes of interest were intraoperative morbidities, including surgical time, operative bleeding, and hypotension; postoperative morbidities such as nausea and vomiting; and coagulation profiles. Results Seven studies comprising 562 participants were reviewed in this study. Operative time (standardized mean difference (SMD) = −0.60; 95% confidence interval (CI)[−0.93, −0.29]) and intraoperative blood loss (SMD = −0.66; 95% CI [−0.86, −0.46]) were statistically lower in the treatment group than placebo group; and the quality of the surgical field (SMD = −0.80; 95% CI [−1.12; −0.48]) and surgeon satisfaction (SMD = 1.74; 95% CI [1.36; 2.13]) were statistically higher in the treatment group than the placebo group. By contrast, there were no significant differences in the hemodynamic (SMD = 0.08; 95% CI [−0.20; 0.37]) and coagulation profiles (SMD = −0.18; 95% CI [−0.42, 0.07]) of the two groups. Additionally, tranexamic acid had no significant effect on emetic or thrombotic events compared to placebo. Conclusion This meta‐analysis showed that the systemic administration of tranexamic acid could decrease operative time and blood loss intraoperatively, increasing the satisfaction of surgeons. It did not provoke intraoperative hemodynamic instability, postoperative emetic events, or coagulation profile abnormality. Only a small number of studies were enrolled, so further trials are needed to confirm the results of this study. Laryngoscope, 129:800–807, 2019

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Kim

Kang

et al. 2018

The Laryngoscope

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“…A number of previous studies have demonstrated the presence of preoperative blood hypercoagulability in RA patients, which is a risk factor of postoperative venous thromboembolism (VTE) [43]. In addition, concerns about the potential pro-coagulation effect of TXA in this high-risk patient population still hinder the wide application of this medication in TKA [44]. Therefore, we plan a prospective randomized controlled study to evaluate the safety of different TXA regimens in RA patients undergoing TKA.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of preemptive antifibrinolysis with tranexamic acid in rheumatoid arthritis patients undergoing total knee arthroplasty: a study protocol for a randomized controlled trial

Lei

Liu

et al. 2020

BMC Musculoskelet Disord

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Background: Patients with rheumatoid arthritis (RA) who have undergone total knee arthroplasty are at increased risk of requiring a blood transfusion. This study is designed to compare the effects of preemptive antifibrinolysis of single-dose and repeat-dose tranexamic acid (TXA) in in RA patients undergoing total knee arthroplasty (TKA). Methods/design: The study will be a double-blind randomized controlled trial with two parallel groups of RA patients. Group A will be given 100 ml normal saline twice daily starting from 3 days before the operation, Group B will be given TXA 1.5 g twice daily starting from 3 days before the operation. All patients will be given TXA 1.5 g 30 min before the operation. The primary outcomes will be evaluated with total blood loss and hidden blood loss. Other outcome measurements such as, fibrinolysis parameters, inflammatory factors, visual analogue scale for postoperative pain, analgesia usage, coagulation parameters, transfusion, the length of stay (LOS), total hospitalization costs, the incidence of thromboembolic events and other complications will be recorded and compared. Recruitment is scheduled to begin on 1 August 2020, and the study will continue until 31 May 2021. Discussion: In current literature there is a lack of evidence with regard to the efficacy of TXA in RA patients. The findings of this study, whether positive or negative, will contribute to the formulation of further recommendations on the use of TXA in RA patients undergoing TKA.

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“…21 In particular, TA in TKA has been shown to reduce the blood loss and transfusion rate without an increased risk of VTE. 8,22,23 It is, however, difficult to elucidate the role of TA in causing VTE since most of the studies exclude high-risk patients in their trials such as history of cardiovascular disease, thromboembolic events, renal failure with creatinine level >250 µmol/l, allergy to TA, and those on warfarin or on therapeutic dose of low molecular weight heparin.…”

Section: Discussionmentioning

confidence: 99%

Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose

Balachandar¹,

Abuzakuk²

2019

J Orthop Surg (Hong Kong)

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Purpose: There is no consensus on the optimum timing of administration of tranexamic acid (TA) in bilateral total knee arthroplasty (TKA). We aimed to determine whether the timing of administration of single-dose intravenous TA (either given preoperatively or intraoperatively) has a significant effect on blood loss reduction. Methods: We compared two cohorts of patients with end-stage arthritis of knees who underwent bilateral TKA and were given single-dose intravenous TA (1 g or 15 mg/kg) at different times during surgery. The retrospective cohort group consisting of 40 patients (preoperative (PO) group) received TA before the skin incision. The prospective cohort consisting of 40 patients (intraoperative (IO) group) received TA 10 min before deflating the tourniquet on the first knee. Primary outcome measures were mean hemoglobin difference, A (between PO and day 1 postoperative hemoglobin), mean hemoglobin difference, B (between PO and lowest postoperative hemoglobin), and rate of allogeneic blood transfusion. Secondary measure was drain blood loss. Results: Both cohorts were well matched with respect to age, gender, duration of surgery, and length of hospital stay. The hemoglobin drop in the IO group was significantly lesser than the PO group on the first postoperative day (2 vs. 2.9 g/dL, p < 0.001). Although statistically insignificant, the patients in the IO group received less allogenic transfusion of packed cell units than in the PO group (11/40, 27.5% vs. 14/40, 35% ). Mean hemoglobin difference, B, and secondary drain loss were comparable in both groups. Conclusion: Single-dose intravenous TA given before the start of surgery is as effective as a dose given during arthroplasty of the first knee in reducing blood loss in bilateral TKA.

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Does tranexamic acid increase the risk of thromboembolism after bilateral simultaneous total knee arthroplasties in Asian Population?

Abstract: The use of tranexamic acid reduces the volume of blood transfusion and does not increase the prevalence of DVT or PE in the patients who did not receive routine chemical thromboprophylaxis after primary bilateral simultaneous sequential TKAs in Asian patients.

Cited by 22 publications

References 24 publications

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Efficacy of tranexamic acid on operative bleeding in endoscopic sinus surgery: A meta‐analysis and systematic review

Effectiveness of preemptive antifibrinolysis with tranexamic acid in rheumatoid arthritis patients undergoing total knee arthroplasty: a study protocol for a randomized controlled trial

Is there an optimal timing of administration of single-dose intravenous tranexamic acid in bilateral total knee arthroplasty? A comparison between preoperative and intraoperative dose

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