Effect of topical tranexamic acid in total hip arthroplasty patients who receive continuous aspirin for prevention of cardiovascular or cerebrovascular events: A prospective randomized study

Qiu, Jiandi; Sun, Xin; Zhang, Weihao; Ke, Xiurong; Gao, Yang; Zhang, Lei

doi:10.1016/j.otsr.2019.06.018

Cited by 15 publications

(23 citation statements)

References 27 publications

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“…With regard to the administration route, the 111 RCTs [ 12 , 15 , 16 , 21 , 22 , 26 , 30 – 35 , 37 – 40 , 42 – 45 , 47 – 55 , 57 , 59 – 64 , 66 – 68 , 70 – 87 , 89 – 95 , 97 – 100 , 103 , 105 – 150 , 152 – 157 ] comparing IV TXA versus controls, on 5,599 and 4,980 patients, respectively, reported a rate of VTE equal to 2.7% and 2.6%, respectively (OR 0.96 [95% CI 0.77-1.20]; p = 0.709). The 45 RCTs [ 11 , 21 , 24 , 25 , 27 , 28 , 36 , 41 , 45 – 47 , 56 , 58 , 65 , 69 , 75 , 79 – 81 , 88 , 96 , 99 , 101 , 102 , 104 – 108 , 117 , 118 , 123 , 126 , 127 , 129 – 132 , 134 – 137 , 139 , 140 , 144 ] comparing IA TXA administration (2,756 patients) and controls (2,495 patients) reported a ...…”

Section: Resultsmentioning

confidence: 99%

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta‐Analysis of Randomized Controlled Trials

Reale

Andriolo

Gürsoy

et al. 2021

BioMed Research International

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Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

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Section: Resultsmentioning

confidence: 99%

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta‐Analysis of Randomized Controlled Trials

Reale

Andriolo

Gürsoy

et al. 2021

BioMed Research International

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“…Studies have reported an increased risk of blood transfusion following primary THA and TKA with a lower pre-operative hemoglobin concentration, lower patient body weight or body mass index (BMI), older age at surgery, female sex, longer operative times, and in patients with a history of cancer, coronary artery disease, or chronic obstructive pulmonary disease, and patients undergoing bilateral TKA 595,604-614 . Studies also found a reduced risk of allogeneic blood transfusion in patients receiving topical tranexamic acid following primary THA 605 , and in patients receiving re-infused blood collected from cell salvage following primary TKA 615 . Additionally, many studies have analyzed the impact VTE prophylaxis has in major bleeding events following joint procedures.…”

Section: - Is There a Risk Stratification System For Predicting Major...mentioning

confidence: 99%

“…Most studies investigating predictors of major bleeding following orthopaedic procedures have included patients undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Studies have reported an increased risk of blood transfusion following primary THA and TKA with a lower pre-operative hemoglobin concentration, lower patient body weight or body mass index (BMI), older age at surgery, female sex, longer operative times, and in patients with a history of cancer, coronary artery disease, or chronic obstructive pulmonary disease, and patients undergoing bilateral TKA 595,604-614 . Studies also found a reduced risk of allogeneic blood transfusion in patients receiving topical tranexamic acid following primary THA 605 , and in patients receiving re-infused blood collected from cell salvage following primary TKA 615 .…”

Section: - Is There a Risk Stratification System For Predicting Major...mentioning

confidence: 99%

Recommendations from the ICM-VTE: General

2022

Journal of Bone and Joint Surgery

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“…First, all patients were treated with oral tramadol sustained-release tablets if the conventional analgesic treatment was not effective, but not all patients were sensitive to this drug; second, patients with coagulation dysfunction, such as taking aspirin, were not included. It has been con rmed that TXA is also safe and effective in patients taking aspirin for a long time [32]. As an antipyretic and analgesic drug, further studies are needed to determine whether preoperative administration of aspirin will affect postoperative opioid use.…”

Section: Discussionmentioning

confidence: 99%

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

Preprint

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Background: The problem of opioid addiction after total hip arthroplasty (THA) has been widely concerned. Tranexamic acid (TXA) has been shown to be effective in reducing blood loss for patients undergoing THA, but few studies focus on its alleviation of postoperative local pain symptoms. The purpose of this study was to investigate whether topical TXA could reduce early postoperative hip pain for primary THA patients, thereby reducing the use of opioids, and whether local pain is related to inflammatory response. Methods: In this prospective randomized controlled study, we randomly divided 161patients into a topical group (n=79) and an intravenous group (n=82). Hip pain was assessed using the visual analogue scale (VAS) score within three days after surgery and tramadol was used for pain relief when necessary. Inflammatory markers such as high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and hemoglobin drop were assessed by hematologic tests. The primary outcomes included the VAS score and dose of tramadol from the first to the third day after surgery. The secondary outcomes included the inflammatory markers level, total blood loss and complications. Results: The pain score and inflammation markers level on the first day in the topical TXA group were significantly lower than those in the intravenous TXA group (P＜0.05). The correlation analysis showed that the VAS score on the first day after surgery was positively correlated with the inflammation markers level (P＜0.05). The tramadol dose for topical group was lower than intravenous group on the first and second day after surgery. There were no differencesin total blood loss between the two groups (640.60± 188.12ml vs. 634.20± 187.85ml, P= 0.06). There was no difference in the incidence of complications. Conclusion: Topical use of TXA could relieve the local pain symptoms and reduce opioid consumption for patients undergoing primary THA by reduce the early postoperative inflammatory response. Trial registration: The trial was registered at the China Clinical Trial Registry (ChiCTR2100052396) on 10/24/2021.

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Effect of topical tranexamic acid in total hip arthroplasty patients who receive continuous aspirin for prevention of cardiovascular or cerebrovascular events: A prospective randomized study

Cited by 15 publications

References 27 publications

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta‐Analysis of Randomized Controlled Trials

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta‐Analysis of Randomized Controlled Trials

Recommendations from the ICM-VTE: General

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

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