Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty

Demos, Harry A.; Lin, Zilan; Barfield, William R.; Wilson, Sylvia H.; Robertson, Dawn C.; Pellegrini, Vincent D.

doi:10.1016/j.arth.2017.02.068

Cited by 36 publications

(35 citation statements)

References 53 publications

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“…To the best of our knowledge, no study has speci cally demonstrated the bene t of TXA in reducing transfusions in traumatised patients. However, standardisation of TXA administration showed a signi cant bene t in the context of hip and knee arthroplasty, including reductions in: perioperative haemoglobin decrement (20%), patients transfused (45%), and number of units transfused per patient (62%) [31]. Concerning the possible impact of using a ROTEM® protocol for the administration of coagulation factors, a retrospective study with trauma patients found signi cantly lower observed mortality when compared to the mortality predicted by the TRISS (24.4% vs 33.7%; p = 0.032) [32].…”

Section: Discussionmentioning

confidence: 99%

Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

Pernod¹,

Fraticelli²,

Marcotte³

et al. 2020

Preprint

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Background: Uncontrolled haemorrhage is still the leading cause of preventable death following trauma. Coagulation resuscitation strategies can be plasma-based or fibrinogen concentrate-based. The aim of this study was to describe the evolution of transfusion practices following the introduction of tranexamic acid (TXA) and ROTEM® in a trauma centre from a teaching hospital.Methods: This is a single-centre, retrospective study at a Trauma Resuscitation Unit (TRU) from a French teaching hospital. All trauma patients aged 18 years or more and transfused with at least 4 red blood cells (RBCs) within 24 hours after trauma, from 2011 to 2016, were included. The primary objective was to analyse transfusion practices over this time period.Assessment of the annual proportion of patients transfused with more than 4 RBCs at 24h, proportion of application of high fresh frozen plasma (FFP):RBC ratio (≥ 1:2 ), and proportion of administration of fibrinogen with ROTEM® protocol and TXA was performed. The secondary objectives aimed at assessing differences between populations according to the FFP:RBC ratio applied and compare all-cause mortality at D30.Results: A total of 122 patients were included. Between 2011 and 2016, there was a significant decrease in the proportion of patients requiring at least 4 RBCs 24h after trauma (9% vs. 3%, Ptrend < 0.0001) as well as a decrease in the proportion of patients with a high FFP:RBC ratio (86% vs. 62% at 6h, Ptrend = 0.0056 and 86% vs. 56% at 24h, Ptrend = 0.0047). After 2013, fibrinogen was administered to more than 70% of patients and TXA to 100% of them. Adherence to the ROTEM® protocol for the administration of fibrinogen was significant. The observed mortality was lower than the predicted one, irrespective of FFP:RBC ratio.Conclusion: From 2011 to 2016, an important evolution of practices occurred in the TRU including a decrease in the proportion of transfusions and use of high FFP:RBC ratios. The origin of these changes is multifactorial, likely including the systematic use of TXA and optimisation of the ROTEM® protocol for fibrinogen administration.

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Section: Discussionmentioning

confidence: 99%

Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

Pernod¹,

Fraticelli²,

Marcotte³

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…This phenomenon may be explained as follows. First, although TXA may have the potential risk of triggering thrombosis, this has not been confirmed. Some authors even suggest that TXA can reduce the risk of thrombosis by reducing the need for blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TXA), a fibrinolytic inhibitor, can effectively and safely reduce perioperative blood loss and transfusion requirements in patients with primary TKA, although the optimal dosage and method of application is still controversial [6][7][8][9][10][11] . As a new strategy for reducing blood loss, adrenaline has also been used recently to reduce perioperative blood loss.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

Zeng

et al. 2018

Orthopaedic Surgery

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The present study assessed the effectiveness of the combined administration of tranexamic acid (TXA) plus low‐dose epinephrine in primary total knee arthroplasty (TKA). We searched the following Chinese electronic databases: China National Knowledge Infrastructure and WanFang Data. We also searched the following English electronic databases: PubMed, Embase, Web of Science, and Central Register of Controlled Trials. To search for additional eligible studies, we also used Google's search engine. All randomized controlled trials (RCT) comparing TXA plus low‐dose epinephrine (Combined group) and TXA alone in TKA were systematically searched. The primary outcomes were total blood loss, hidden blood loss, the requirement for transfusion, maximum hemoglobin (Hb) drop, and deep venous thrombosis (DVT). Drainage volume, operation time, length of stay, hospital for special surgery (HSS) score, and range of motion (ROM) were considered as secondary outcomes. Subgroup analyses were performed to assess the benefits of using a tourniquet and the application routes of topical or intravenous TXA between the two groups. Statistical analysis was assessed using RevMan 5.3 software. Four independent RCT were included involving 426 patients, with 213 patients in the Combined group and 213 patients in the TXA alone group. In the Combined group there was significant reduction in total blood loss (MD, 204.70; 95% CI, −302.76 to −106.63; P < 0.0001), hidden blood loss (MD, 185.63; 95% CI, −227.56 to −143.71; P < 0.00001), drainage volume (MD, 93.49; 95% CI, −117.24 to −69.74; P < 0.00001), and maximum Hb drop (MD, 5.33, 95% CI, −6.75 to −3.91; P < 0.00001). No statistical differences were found postoperatively in terms of the requirement for transfusion (risk ratio, 0.52; 95% CI, 0.26–1.04; P = 0.06), operation time (MD, 0.85; 95% CI, −2.62 to 4.31; P = 0.63), length of stay (MD, −0.02; 95% CI, −0.52 to 0.47; P = 0.93), HSS score (MD, 0.78; 95% CI, −0.36 to 1.92; P = 0.18), and ROM (MD, 1.40; 95% CI, −1.01 to 3.81; P = 0.26), and not increasing the risk of DVT (risk ratio, 1.00; 95% CI, 0.33 to 3.02; P = 1.00) in the two groups. This meta‐analysis demonstrated that the administration of tranexamic acid plus low‐dose epinephrine is a safe and efficacious treatment to reduce total blood loss, hidden blood loss, drainage volume, and maximum Hb drop in primary TKA, without increasing the risk of DVT in primary THA.

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“…In recent 10 years, surgical techniques and perioperative management guidelines have made gratifying progress in THA, promoting the rapid recovery of patients. Tranexamic acid (TXA), a synthetic analog of lysine, inhibits fibrinolysis by competitively blocking the lysine binding site of plasminogen, often used for joint replacement to reduce perioperative blood loss, and it has anti‐inflammatory effects. Dexamethasone (DEX), with a strong anti‐inflammatory agent, has been widely used to reduce inflammatory markers, prevent PONV, and relieve postoperative pain and fatigue in various perioperative periods.…”

Section: Introductionmentioning

confidence: 99%

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

et al. 2020

Orthopaedic Surgery

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Objective: To evaluate the efficacy and safety of combined use of tranexamic acid (TXA) and dexamethasone (DEX) for anti-inflammatory and clinical outcomes after total hip arthroplasty (THA). Methods:A total of 100 patients were included in this randomized, controlled study. Patients in the TXA + DEX group were administered TXA at a dose of 15 mg/kg, which was repeated 3 h after THA, and received 20 mg DEX. In contrast, patients in the TXA group were administered TXA at a dose of 15 mg/kg, which was repeated at 3 h postoperatively. C-reactive protein (CRP), interleukin-6 (IL-6) and pain levels, incidence of postoperative nausea and vomiting (PONV), total blood loss and transfusion rates, postoperative fatigue, range of motion (ROM), length of hospital stay (LOS), analgesic rescue and antiemetic rescue consumption, and complications were compared in both groups. Results:The CRP and IL-6 levels were lower in the TXA + DEX group than in the TXA group (all P < 0.001) at 24 h, 48 h, and 72 h postoperatively. Patients in the TXA + DEX group had lower pain scores at rest and walking at 24 h postoperatively (all P < 0.001). In the TXA + DEX group, the incidence of PONV was lower (P = 0.005), postoperative fatigue (P < 0.001) was reduced, and analgesia and antiemetic rescue consumption were also reduced. The total blood loss, transfusion rate, LOS and hip ROM were similar in the two groups. There was no thrombosis, infection, or gastrointestinal bleeding in either group.Conclusion: Compared to TXA alone, the combination of TXA + DEX can reduce postoperative inflammatory response, relieve pain, and reduce PONV and fatigue, without increasing the risk of complications. Therefore, the present study suggested that the combination of TXA + DEX is an effective and safe accelerated rehabilitation strategy for patients receiving primary unilateral THA.

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Process Improvement Project Using Tranexamic Acid Is Cost-Effective in Reducing Blood Loss and Transfusions After Total Hip and Total Knee Arthroplasty

Cited by 36 publications

References 53 publications

Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

Evolution of practices in a French trauma centre: decrease in blood transfusions and fresh frozen plasma to red blood cell ratios.

Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

Combined Application of Dexamethasone and Tranexamic Acid to Reduce the Postoperative Inflammatory Response and Improve Functional Outcomes in Total Hip Arthroplasty

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