Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

Yoon, Byung‐Ho; Kim, Tae Young; Ko, Young Seung; Lee, Yong Seuk; Ha, Yong‐Chan; Koo, Kyung‐Hoi

doi:10.1371/journal.pone.0206480

Cited by 15 publications

(19 citation statements)

References 45 publications

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“…Several strategies have been used to minimize blood loss and to avoid blood transfusion, which may cause adverse effects, such as infection and transfusion reactions [1,3]. In this regard, pre-and postoperative administration of tranexamic acid has been effective [13][14][15]. However, its use is contraindicated in patients with a history of thromboembolism, and is associated with adverse events, such as allergies [16].…”

Section: Discussionmentioning

confidence: 99%

Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture – a randomized clinical trial

Lucas

Riebau

Mohr

et al. 2021

BMC Musculoskelet Disord

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Background One of the most common complications of hip arthroplasty is excessive blood loss that could necessitate allogenic blood transfusion, which is further associated with other complications, such as infections, transfusion reactions or immunomodulation. In gynecology, 4DryField®PH, an absorbable polysaccharide-based formulation, is used for hemostasis and adhesion prophylaxis. In this study, we evaluated its hemostatic effect in patients undergoing hip bipolar hemiarthroplasty following intracapsular femoral neck fracture. Methods We studied 40 patients with intracapsular femoral neck fractures (Garden III or IV) admitted at our institution between July 2016 and November 2017. We included patients above 60 years with simple fracture and without pathologic fractures. Patients were randomized into intervention and control groups. The intervention group received 5 g of 4DryField® PH (subfascially and subcutaneously) during wound closure. Three drainages were inserted in a standardized manner (submuscular, subfascial, and subcutaneous) and drainage volume was measured immediately before extraction. Total blood loss was calculated using Mercuriali’s formula and standard hemograms upon admission and five days after surgery. Volume of postoperative hematoma was measured using point-of-care ultrasound seven days after surgery. Results Volume of the postoperative hematoma was reduced by 43.0 mL. However, significant reduction of total blood loss and drainage volume was not observed. Conclusions We observed that 4DryField® PH had a local hemostatic effect, thereby reducing volume of the postoperative hematoma. However, this reduction was small and had no effect on the total blood loss. Further studies are warranted to improve the application algorithm. Trial registration DRKS, DRKS00017452, Registered 11 June 2019 – Retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture – a randomized clinical trial

Lucas

Riebau

Mohr

et al. 2021

BMC Musculoskelet Disord

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“…A meta-analysis by Zhang et al has shown no difference between the two ways of TXA application in THAs [4]. Network meta-analysis revealed that the best strategy is to combine IV pre-incision TXA with intra-articular application [24][25][26]. However, this would not be applicable to patients with increased risk for thromboembolic events, who are usually excluded from randomised trials.…”

Section: Discussionmentioning

confidence: 99%

“…The network meta-analysis of Fillingham et al [26] revealed that the topical application of TXA significantly reduced the transfusions in TKAs. A recent meta-analysis of series with THAs showed that only combined IV and intra-articular administration significantly reduced the need for blood transfusions [24].…”

Section: Discussionmentioning

confidence: 99%

Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement?

et al. 2020

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The intra-articular use of tranexamic acid (TXA) has contributed to reduced blood loss in total joint arthroplasty (TJA). The purpose of this study is to assess the efficacy of simultaneously topical use of tranexamic acid and vancomycin powder within the TJA space. From 2016 to 2017, 219 consecutive total hip arthroplasties (THAs) and 272 total knee arthroplasties (TKAs) were performed in a tertiary care center, with a group of patients receiving intra-articular TXA and vancomycin, compared to patients receiving only TXA and to a control group that did not receive anything. Haemoglobin and hematocrit were measured preoperatively, on the first and third days. Transfusions and adverse events were recorded. Haemoglobin and hematocrit dropped significantly in all THA and TKA groups till the third day postoperatively, with a major reduction in the control group, compared to the other two treatment groups. Infections and thromboembolic events were similar in either group of the TJAs. In conclusion, the topical use of tranexamic acid mixed with the vancomycin powder within the joint space after the TJAs of the hip and knee did not alter the anti-fibrinolytic effect of TXA.

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“…[ 3 , 4 ] These agents effectively reduce postoperative bleeding by inhibiting fibrinolysis and thrombus degradation. [ 5 ]…”

Section: Introductionmentioning

confidence: 99%

Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty

et al. 2021

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Background: Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA). Methods: Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications. Results: Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA. Conclusions: The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.

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Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

Cited by 15 publications

References 45 publications

Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture – a randomized clinical trial

Effect of 4DryField® PH on blood loss in hip bipolar hemiarthroplasty following intracapsular femoral neck fracture – a randomized clinical trial

Does Intra-Wound Vancomycin Powder Affect the Action of Intra-Articular Tranexamic Acid in Total Joint Replacement?

Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty

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