Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty

Zhang, Yan; Zhang, Junwei; Wang, Baohua

doi:10.1097/md.0000000000007363

Cited by 5 publications

(3 citation statements)

References 29 publications

(36 reference statements)

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“…As in the previous study, [ 36 , 37 ] our meta-analysis findings showed that compared to the single strategies, the combined application of both drain-clamping and TXA administration was associated with significant reductions in total blood loss, blood loss in drainage, hemoglobin decreases, and transfusion requirements. Zhang et al [ 36 ] found that compared to TXA alone, drain-clamping alone, or control treatment, TXA plus drain-clamping achieved a maximal hemostasis effect in patients undergoing primary TKA. Furthermore, the results reported by Liao et al [ 37 ] were similar.…”

Section: Discussionsupporting

confidence: 79%

Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

Han¹,

Huang

Pan

et al. 2018

Medicine

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Background:To compare the efficacy and safety of the combined application of both drain-clamping and tranexamic acid (TXA) versus the single use of either application in patients with total-knee arthroplasty (TKA).Methods:Databases (EMBASE, PubMed, Cochrane Library, Web of Sciences, the Google database, and the Ovid database) were searched from their inception through April 2018 for randomized controlled trials (RCTs) comparing the combined application of both drain-clamping and TXA versus single use of either application in patients with TKA. The Cochrane risk of bias (ROB) tool was used to assess the methodologic quality. The primary outcomes were blood loss in drainage, total blood loss, transfusion rate, and hemoglobin decline. The secondary outcomes were postoperative complications, the Knee Society Score (KSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The statistical analysis was performed with RevMan 5.3.5 software.Results:A total of five RCTs (479 participants) were included in our meta-analysis. The present meta-analysis indicated that significant differences existed in the total blood loss (mean difference [MD] = −145.86, 95% confidence interval [CI]: −228.64 to −63.08, P = .0006), blood loss in drainage (MD = −169.06, 95% CI: −248.56 to −89.57, P < .0001), hemoglobin decline (MD = −0.66, 95% CI: −1.00 to −0.33, P = .0001), and transfusion rate (MD = 0.44, 95% CI: 0.26–0.75, P = .002) between the groups. However, regarding postoperative complications, no significant differences were found between the 2 groups in the KSS and the WOMAC score (P > .05).Conclusion:Combined application of both drain-clamping and TXA was associated with significant reductions in blood loss in drainage, total blood loss, hemoglobin decline, and the need for transfusion. However, high-quality, well-designed RCTs with long-term follow-up are still required.

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Section: Discussionsupporting

confidence: 79%

Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

Han¹,

Huang

Pan

et al. 2018

Medicine

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“…Protocols for temporary clamping time remain controversial. Previous studies 7 16 23) showed that maintaining clamping for 3 hours was more effective in reducing blood loss than no clamping or longer clamping. Jeon et al 16) reported that the drained blood volume in 3-hour clamping or 4-hour clamping was significantly less than that in conventional negative drainage.…”

Section: Discussionmentioning

confidence: 97%

“… 5) However, the combination method is more effective in lowering the volume of closed suction drainage. 5 6 7 8 9 10) …”

mentioning

confidence: 99%

Temporary 12-Hour Drain Clamping versus 3-Hour Drain Clamping in Simultaneous Bilateral Total Knee Arthroplasty

et al. 2023

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Background Total knee arthroplasty (TKA) is a procedure that has a risk of perioperative blood loss and allogeneic blood transfusion. The purpose of the present study was to compare the perioperative blood loss and transfusion rate between the 3-hour interval clamping and 12-hour interval clamping of closed suction drainage after simultaneous bilateral total knee arthroplasty (SBTKA). Methods A total of 122 SBTKAs were enrolled in this retrospective study. A 3-hour clamping protocol was applied in 53 SBTKAs and a 12-hour clamping protocol was applied in 69 SBTKAs. The amount of perioperative blood loss, transfusion requirements, postoperative hemoglobin and hematocrit levels, the lowest hemoglobin and hematocrit levels during hospitalization, readmission within 90 days, and clinical outcomes were compared between the 3-hour clamping group and the 12-hour clamping group. Results The 12-hour clamping group had fewer patients requiring transfusion (26.1%, 18/69) than did the 3-hour clamping protocol group (49.1%, 26/53) ( p = 0.008). The 12-hour clamping group had a lower amount of estimated blood loss (1,426.9 ± 421.5 mL) than did the 3-hour clamping protocol group (1,882.1 ± 445.6 mL) ( p < 0.001). The 12-hour clamping group showed higher hemoglobin and hematocrit levels (both p < 0.001) on postoperative day 5 than did the 3-hour clamping group. The lowest hemoglobin and hematocrit levels were higher in the 12-hour clamping group than in the 3-hour clamping group ( p = 0.039 and p = 0.016, respectively). Within 1 postoperative month, there were 2 cases of wound dehiscence in each group ( p = 0.585). But, at 1 year after the operation, no serious complications occurred in the two groups. Conclusions Compared to the 3-hour clamping protocol, the 12-hour clamping protocol significantly reduced transfusion requirements, estimated blood loss volume, and hemoglobin and hematocrit levels after SBTKA. We suggest that 12-hour temporary clamping should be considered for reducing transfusion rates.

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Similar thromboprophylaxis with rivaroxaban and low molecular weight heparin but fewer hemorrhagic complications with combined intra-articular and intravenous tranexamic acid in total knee arthroplasty

Karampinas

Megaloikonomos

Lampropoulou-Adamidou

et al. 2018

Eur J Orthop Surg Traumatol

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Efficacy of tranexamic acid plus drain-clamping to reduce blood loss in total knee arthroplasty

Cited by 5 publications

References 29 publications

Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

Is the combined application of both drain-clamping and tranexamic acid superior to the single use of either application in patients with total-knee arthroplasty?

Temporary 12-Hour Drain Clamping versus 3-Hour Drain Clamping in Simultaneous Bilateral Total Knee Arthroplasty

Similar thromboprophylaxis with rivaroxaban and low molecular weight heparin but fewer hemorrhagic complications with combined intra-articular and intravenous tranexamic acid in total knee arthroplasty

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