Is intravenous tranexamic acid effective in reduction of blood loss during pelvic and acetabular surgery?

Sharaby, Mohamed; El-Deeb, Younes M

doi:10.1007/s00264-022-05416-y

Cited by 8 publications

(4 citation statements)

References 31 publications

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“…There have been several recent studies evaluating the use of TXA for pelvis and acetabular surgery. [2][3][4][5] Two of these studies were meta-analyses where one showed TXA did decrease transfusion and the other showed TXA did not decrease transfusion; however, both studies combined analysis for both pelvis and acetabular fracture surgery, with any approach used for acetabular exposure. 3,4 Another recent, prospective randomized double-blind study evaluating the use of TXA in 63 patients with open treatment for acetabular fractures showed TXA did not affect transfusion rates or blood loss.…”

Section: Discussionmentioning

confidence: 99%

“…Many surgeons hold VTE prophylaxis the morning of surgery for large cases such as ORIF of the acetabulum and give TXA in an attempt to reduce transfusion with little evidence these interventions are effective. [2][3][4][5]7,8 We attempted to look at several factors that might affect transfusion rates including but not limited to TXA use and holding VTE prophylaxis when performing the AIP approach.…”

Section: Discussionmentioning

confidence: 99%

“…However, there continues to be controversy whether TXA has a clinical benefit when used for open treatment of acetabulum fractures. [2][3][4][5] Another common practice is to hold venous thromboembolism (VTE) prophylaxis the morning of surgery for major surgery such as a planned anterior intrapelvic (AIP) approach.…”

mentioning

confidence: 99%

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Tranexamic Acid and Holding Venous Thromboembolism Prophylaxis Morning of Surgery Do Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular Open Reduction and Internal Fixation

Mullis,

Chang,

Shah

et al. 2024

J Am Acad Orthop Surg

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Introduction: The objective of this study was to determine factors that may affect transfusion rates for patients requiring an anterior intrapelvic (AIP) approach for an acetabulum fracture. Methods: This was a multicenter retrospective comparison study (3 trauma centers at two urban academic centers). Patients who had an AIP approach for an acetabulum fracture without other notable same-day procedures (irrigation and débridement and/or external fixation were only other allowed procedures) were included. One hundred ninety-five adult (18 and older) patients had adequate records to complete analysis with no preexisting coagulopathy. The main outcome evaluated was the number of units transfused at the time of surgery and up to 7 days after surgery. Results: Factors that were found to affect intraoperative transfusion rates were older age, lower preoperative hematocrit, longer surgery duration, and requiring increased intraoperative intravenous fluids. Factors that did not affect transfusion rate included sex, body mass index, hip dislocation at the time of injury, fracture pattern, AIP approach alone or with lateral window ± distal extension, Injury Severity Score, preoperative platelet count, use of tranexamic acid, and venous thromboembolism prophylaxis received morning of surgery. When followed out through the remainder of a week after surgery, the results for any factor did not change. Discussion: In this large multicenter retrospective study of patients requiring an AIP approach, tranexamic acid and use of venous thromboembolism prophylaxis (or holding it the morning of surgery) did not affect transfusion rates either during surgery or up to a week after surgery. Older age, lower preoperative hematocrit level, longer surgery time, and increased intraoperative intravenous fluids were associated with higher transfusion rates. Data availability and trial registration numbers: Data are available on request. Level of evidence: Level 3, retrospective case-control study.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tranexamic Acid and Holding Venous Thromboembolism Prophylaxis Morning of Surgery Do Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular Open Reduction and Internal Fixation

Mullis,

Chang,

Shah

et al. 2024

J Am Acad Orthop Surg

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“…8 Intravenous TXA is used in various surgical specialties, such as cardiac surgery, orthopaedic surgery, and obstetrics, where it reduces perioperative blood loss and the need for transfusion by one-third. [9][10][11][12][13] TXA is efficacious in reducing blood loss when used topically during surgery, intravenously with or without postoperative maintenance treatment, or the abovementioned combination. The reported topical dose of TXA ranges from 1 to 3 g TXA per 100 mL saline, with no optimal dose established.…”

mentioning

confidence: 99%

Intravenous Tranexamic Acid Reduces Blood Loss in Multilevel Spine Surgeries

Lotan

Lengenova

Rijini

et al. 2022

J Am Acad Orthop Surg

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Introduction:Complex spine surgeries are associated with notable blood loss requiring numerous strategies to preserve blood volume. Tranexamic acid (TXA) is efficacious in reducing blood loss when used topically during surgery, intravenously with or without postoperative maintenance treatment. We aimed to evaluate the effect of preoperative weight-independent intravenous administration of 1 g intravenous TXA on perioperative blood loss in lumbar microdiskectomy, single-level lumbar spinal fusion, and multilevel lumbar decompression (two or more levels).Methods:This is a retrospective cohort study comparing patients who underwent microdiskectomy, single-level lumbar fusion, and multilevel laminectomies with and without preoperative IV TXA administration between 2016 and 2020.Results:Two hundred ten patients underwent spine surgery without preoperative IV TXA administration between 2016 and 2018 compared with 109 patients who received preoperative 1 g of IV TXA between 2018 and 2020. Preoperative IV TXA treatment did not change blood loss after microdiskectomy, 77.2 ± 53.9 mL and 77.2 ± 95.2 mL, respectively (P = 0.792). Preoperative IV TXA treatment reduced blood loss after multilevel lumbar laminectomy and lumbar posterior spinal fusion with a transforaminal intervertebral fusion (PSF and TLIF) (P = 0.004 and P = 0.0001, respectively). The same effect was found for intraoperative blood loss and postoperative drainage, with preoperative TXA administration reducing intraoperative blood loss and postoperative drainage for the multilevel lumbar laminectomy and lumbar PSF and TLIF cohorts. No IV TXA treatment adverse events were registered in all cohorts.Conclusion:A routine administration of preoperative weight-independent 1 g intravenous TXA protocol is efficacious and safe in reducing perioperative blood loss for lumbar multilevel laminectomies and PSF and TLIFs.

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Comment on “Is intravenous tranexamic acid effective in reduction of blood loss during pelvic and acetabular surgery?”

Wang

Tang

Wang

2022

International Orthopaedics (SICOT)

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Is intravenous tranexamic acid effective in reduction of blood loss during pelvic and acetabular surgery?

Cited by 8 publications

References 31 publications

Tranexamic Acid and Holding Venous Thromboembolism Prophylaxis Morning of Surgery Do Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular Open Reduction and Internal Fixation

Tranexamic Acid and Holding Venous Thromboembolism Prophylaxis Morning of Surgery Do Not Decrease Transfusion Requirements in Patients Undergoing Anterior Intrapelvic Approach for Acetabular Open Reduction and Internal Fixation

Intravenous Tranexamic Acid Reduces Blood Loss in Multilevel Spine Surgeries

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