Efficacy and Safety of Fibrin Glue and Tranexamic Acid to Prevent Postoperative Blood Loss in Total Knee Arthroplasty

Abstract

Neither type of fibrin glue was more effective than routine hemostasis in reducing postoperative bleeding and transfusion requirements, and we no longer use them. However, this trial supports findings from previous studies showing that intravenous tranexamic acid can decrease postoperative blood loss.

One step closer to sparing total blood loss and transfusion rate in total knee arthroplasty: a meta-analysis of different methods of tranexamic acid administration

“…Out of the 31 studies (Table 2), two were triple-blind [22,23], 20 were double-blind [8,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42], three were single-blind [43][44][45], one study was non-blinded [46], and the blinding was unclear in five of the studies [47][48][49][50][51]. In one study, the randomization was performed by a person/ pharmacist/resident who was not involved in the study or the care of patients [35].…”

Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

“…Prior to this study, Aguilera et al arrived at a similar conclusion, favoring IV-TXA over FS (15). The efficacy of FS has been debated as some surgeons have found FS to be ineffective (14)(15)(16).…”

“…Prior to this study, Aguilera et al arrived at a similar conclusion, favoring IV-TXA over FS (15). The efficacy of FS has been debated as some surgeons have found FS to be ineffective (14)(15)(16). Their finding could be true or it could also be due to insufficient dosage (23) or improper topical application (24).…”

“…TXA is an antifibrinolytic that binds to specific sites of both plasminogen and plasmin, competitively inhibiting the activation of plasminogen to plasmin and thus inhibiting dissolution of clots. Opinions are mixed over the true efficacy of FS in reducing perioperative blood loss and reducing the need for blood transfusion (10)(11)(12)(13)(14)(15)(16). In contrast, multiple trials have clearly demonstrated that TXA is highly reliable (17)(18)(19)(20).…”

The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

“…Administration of tranexamic acid intra-articular or intravenous had no significant difference in blood loss or transfusion rate. [15][16][17][18] However, there was a significant difference between the group that was given tranexamic acid with the control group that was not given tranexamic acid in term of transfusion need. This result is linear with Sabatini et al 12 whom stated that tranexamic acid had protective effect in the need of transfusion.…”