Intra-Articular Tranexamic Acid Wash during Bilateral Total Knee Arthroplasty

Zhu, Meng; Chen, Jerry; Yew, Andy Khye Soon; Chia, Shi‐Lu; Lo, Ngai Nung; Yeo, Seng Jin

doi:10.1177/230949901502300305

Cited by 10 publications

(6 citation statements)

References 24 publications

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“…To date, only a few studies have demonstrated the effectiveness of TXA in simultaneous, bilateral TKA (Table 1) [1, 3, 4, 6, 9-11, 13, 21, 22, 26], and only one recent study [4] directly compared different dosing regimens of intravenous TXA in this cohort. Goyal et al [4] analyzed the difference between a single dose of TXA and three doses of TXA and found no differences in the mean drop in hemoglobin, mean drop in hematocrit, and need for blood transfusions between groups.…”

Section: Introductionmentioning

confidence: 99%

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA

Wilde

Copp

Ezzet

et al. 2021

Clin Orthop Relat Res

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Background Tranexamic acid (TXA) is often used to prevent excessive blood loss during bilateral TKA. Although it diminishes blood loss, TXA may have a potentially elevated thrombogenic risk with extra, unnecessary doses of TXA in this high-risk population. To date, the most efficacious dosing protocol in this setting has not yet been ascertained. Questions/purposes We compared one versus two doses of intravenous TXA in the setting of same-day bilateral TKA in terms of (1) perioperative blood loss that occurred during the hospital stay, (2) transfusion usage during the hospital stay, and (3) major complications occurring within 30 days of surgery.Methods Between August 2013 and October 2016, 309 patients underwent simultaneous bilateral TKA performed by one of five attending surgeons. During that time, indications for same-day bilateral TKA included bilateral knee pathology in which each knee was independently indicated for TKA and the patient preferred bilateral simultaneous TKAs versus staged bilateral surgeries. Patients who had cardiac disease or an American Society for Anesthesiologists physical classification score of greater than 2 were not generally indicated for bilateral simultaneous TKAs. After preoperative clearance from the primary physician and/or specialists as necessary, the decision for This study was funded by a grant from the Scripps Clinic Medical Group Foundation. One of the authors (WDB) certifies receipt of personal payments or benefits, during the study period (2013)(2014)(2015)(2016), in an amount of USD 10,000 to USD 100,000 from Zimmer Biomet; in an amount of USD 100,001 to USD 1,000,000 from DePuy; in an amount of USD 10,000 to USD 100,000 from Smith & Nephew; in an amount of less than USD 10,000 from Orthalign Inc; and in an amount of USD 10,000 to USD 100,000 from Medical Device Business Services Inc. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Ethical approval for this study was obtained from the Scripps Institutional Review Board,

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Section: Introductionmentioning

confidence: 99%

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA

Wilde

Copp

Ezzet

et al. 2021

Clin Orthop Relat Res

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“…A total of 383 records were identified of which finally 69 were found appropriate for inclusion in the present meta‐analysis (fig. ).…”

Section: Resultsmentioning

confidence: 99%

Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta‐Analysis of Randomized, Controlled Trials and Cohort Studies

Sridharan

Sivaramakrishnan

2017

Basic Clin Pharma Tox

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Tranexamic acid (TXA) has been shown to be effective in patients with total knee arthroplasty (TKA) in clinical studies with no consensus with regard to the most appropriate route of administration. We conducted a network meta-analysis to compare the evidence available on efficacy and safety of TXA in TKA. Electronic databases were searched for randomized, clinical trials and cohort studies that evaluated TXA in TKA. Publication bias, risk of bias and inconsistencies were assessed. Direct and indirect comparisons were carried out for blood transfusion rate and incidence of thrombotic complications. Sensitivity analyses and grading of evidence were performed for key comparisons. A cumulative meta-analysis was conducted for comparisons that had a minimum of 10 included studies. A total of 19 studies with 8916 participants were pooled for this network meta-analysis. No inconsistencies and publication bias were observed. Low risk of bias was observed for the majority of the included studies. When compared to placebo, the pooled estimates for mixed treatment analyses favoured (in the order of higher ranking) the combined pre-operative oral and topical TXA, intra-operative intravenous TXA with topical TXA, pre-operative intravenous TXA, intra-operative and post-operative intravenous TXA, intra-operative intravenous bolus and topical TXA. Additionally, combined intravenous and topical TXA performed better than topical TXA alone. No significant changes were observed in the sensitivity analyses. No significant differences were observed in the risk of thrombotic complications between the interventions. TXA is efficacious and safe in patients with TKA. The combined topical and intra-operative intravenous TXA may perform better.

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“…The effectiveness of intravenous TXA in simultaneous bilateral total knee arthroplasty was reported in previous retrospective comparative studies 20 - 22 and randomized controlled trials 15 , 23 . The effectiveness of intra-articular TXA was also reported in a retrospective comparative study 24 . Several randomized controlled trials compared the effectiveness of intravenous TXA with that of intra-articular TXA 25 , 26 .…”

Section: Discussionmentioning

confidence: 96%

Combined Intravenous and Intra-Articular Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty without Tourniquet Use

Tsukada

Wakui²

2017

JBJS OA

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Background:A combined intravenous and intra-articular regimen is one of the most effective administration routes of tranexamic acid (TXA) to reduce perioperative blood loss in unilateral total knee arthroplasty. However, there have been few reports regarding use of the combined regimen for patients undergoing simultaneous bilateral total knee arthroplasty, in which blood-management strategy is more challenging.Methods:We compared perioperative blood loss in 30 consecutive patients undergoing simultaneous bilateral total knee arthroplasty who received both 1,000 mg of TXA intravenously and 1,000 mg of intra-articular TXA in each knee (combined TXA group) with that in a consecutive series of 51 patients who only received 1,000 mg of TXA intravenously (intravenous TXA group). Additional intravenous TXA was administered 6 hours after the initial administration in both groups. Except for the intraoperative TXA administration regimen, an identical perioperative blood-management strategy was applied to both groups; this consisted of transfusion of 800 or 400 mL of predeposited autologous blood except for patients with a preoperative hemoglobin level of <11.0 g/dL, who received 4 units of allogenic blood. All surgical procedures were performed with spinal anesthesia and without use of a pneumatic tourniquet. Perioperative blood loss was calculated using the blood volume and change in hemoglobin level from the preoperative measurement to postoperative day 3.Results:There was significantly less perioperative blood loss in the combined TXA group compared with the intravenous TXA group (mean and standard deviation, 1,201 ± 347 versus 1,638 ± 400 mL, respectively; mean difference, 437 mL; 95% confidence interval, 263 to 613 mL; p < 0.0001). No patient in the combined TXA group and 1 patient (2%) in the intravenous TXA group required additional allogenic blood transfusion. No thrombotic events occurred in either group.Conclusions:In a nonrandomized comparison, combined intra-articular and intravenous TXA significantly reduced the calculated perioperative blood loss in simultaneous bilateral total knee arthroplasty compared with that found in patients treated only with intravenous TXA.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Intra-Articular Tranexamic Acid Wash during Bilateral Total Knee Arthroplasty

Cited by 10 publications

References 24 publications

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA

No Difference in Blood Loss and Risk of Transfusion Between Patients Treated with One or Two Doses of Intravenous Tranexamic Acid After Simultaneous Bilateral TKA

Tranexamic Acid in Total Knee Arthroplasty: Mixed Treatment Comparisons and Recursive Cumulative Meta‐Analysis of Randomized, Controlled Trials and Cohort Studies

Combined Intravenous and Intra-Articular Tranexamic Acid in Simultaneous Bilateral Total Knee Arthroplasty without Tourniquet Use

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