Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

Xu, Qintong; Yang, Yi; Shi, Peng; Zhou, Jian; Dai, Wenda; Yao, Zhenjun; Zhang, Chi

doi:10.5582/bst.2014.01063

Cited by 11 publications

(11 citation statements)

References 38 publications

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“…A consensus has not been reached regarding administration time, dosage, and method of TXA administration in TKA [18–20]. Maniar et al [18] compared the clinical effects of pre-operative, intra-operative, and post-operative uses of TXA; results showed that pre-operative use is superior at the time point when the tourniquet is loosened.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Tranexamic Acid for Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

et al. 2015

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BackgroundTotal knee arthroplasty (TKA) is associated with significant perioperative blood loss and need for transfusion. This study aimed to evaluate the effectiveness and safety of tranexamic acid (TXA) to reduce perioperative blood loss in patients receiving TKA.Material/MethodsA total of 92 patients who accepted unilateral TKA from May 2012 to May 2013 randomly received either 15 mg/kg TXA in 100 mL normal saline solution (TXA group, n=46) or the same amount of normal saline solution (placebo group, n=46) at 15 min before the tourniquet was loosened. The following data were recorded: intraoperative blood loss; post-operative drainage at 12 h; total drainage amount; hidden blood loss; total blood loss; transfusion volumes; number of transfusions; post-operative hemoglobin at 1, 3, and 5 days; D-dimer; number of lower limb ecchymoses; and deep vein thrombosis (DVT).ResultsA total of 81 patients were available for analysis (TXA group, n=41; placebo group, n=40). Post-operative12-h drainage, post-operative 24-h D-dimer values, total drainage volume, hidden blood loss, total blood loss, and the rate of postoperative ecchymosis were lower in the TXA group than in the placebo group (p<0.05). The post-operative 3-day Hgb was higher in the TXA group than in the placebo group (p=0.000). The rate of transfusion and DVT was similar in both groups (n.s.).ConclusionsPerioperative blood loss could be reduced after TKA by intravenously injecting 15 mg/kg TXA at 15 min before the tourniquet was loosened. The application of TXA is not associated with increased risk of DVT.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Tranexamic Acid for Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

et al. 2015

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“…TEG assessments can be used to measure and graphically display the changes in viscoelastic properties of blood samples (i.e. perioperative reaction time [ R ], rate of thrombus formation [ k ], maximum amplitude [MA], α‐angle, lysis rate at 30 min [LY30], and coagulation index [CI, overall coagulation status]) under low‐shear conditions . Blood samples for TEG analyses were activated with kaolin as a coagulation activator, and processed within 1 h of blood draw at 37 °C in a stationary cylindrical cup .…”

Section: Methodsmentioning

confidence: 99%

“…The rotation movement of the pin was converted to an electrical signal, which can be displayed as a typical TEG trace by use of a computerized coagulation analyser (TEG5000; Haemoscope, Niles, IL, USA) . The TXA concentration was also measured at each time point with tandem liquid chromatography mass spectrometry .…”

Section: Methodsmentioning

confidence: 99%

The antifibrinolytic and anti‐inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial

Wang

Luo

et al. 2018

Journal of Thrombosis and Haemostasis

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The antifibrinolytic and anti-inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial. J Thromb Haemost 2018; 16: 2442-53. maximum reductions in blood loss and inflammatory response, improved analgesia, and promoted early rehabilitation. Further studies are required to ensure that these findings are reproducible. A B C D Fig. 4. Postoperative clinical outcomes.Patient-rated pain with 45°knee flexion (A) and at rest (B), knee circumference (local inflammation) (C) and range of motion (ROM) (D) after total knee arthroplasty. *Significantly different (P < 0.05) between groups A and B. †Significantly different (P < 0.05) between groups A and C. ‡Significantly different (P < 0.05) between groups A and D. §Significantly different (P < 0.05) between groups A and E. ¶Significantly different (P < 0.05) between groups B and C. **Significantly different (P < 0.05) between groups B and D. † †Significantly different (P < 0.05) between groups B and E. ‡ ‡Significantly different (P < 0.05) between groups C and D. § §Significantly different (P < 0.05) between groups C and E. ¶ ¶Significantly different (P < 0.05) between groups D and E. POD, postoperative day. [Color figure can be viewed at wileyonlinelibrary.com]

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“…Tranexamic acid (TXA), a synthetic derivative of lysine, prevents fibrinolysis by reversible blockade of the lysine-binding sites of plasminogen, thereby achieving the goal of local hemostasis and reducing bleeding (6,7). Currently, TXA has been widely used in many areas of surgery, such as, cardiovascular surgery, gastrointestinal bleeding, postpartum hemorrhage, orthotopic liver transplantation, and hip and knee arthroplasty (8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials

Xiong

Wang

et al. 2015

DD&T

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Tranexamic acid (TXA) is an antifibrinolytic drug which has been widely used in many areas of surgery. The purpose of our meta-analysis was to review randomized controlled trials (RCT) of the effectiveness and safety of topical TXA treatment in reducing total blood loss and transfusion rate for patients undergoing primary total hip arthroplasty (THA). A literature search was undertaken. Five eligible reports match the inclusion and exclusion standard. The topical administration of TXA groups revealed lower total blood loss(mean difference - 347 ml, 95% CI, - 411 to - 282 mL; p < 0.00001) and transfusion rate (OR, 0.23 (p < 0.00001; 95% CI, 0.14-0.38)) compared with control groups. Meanwhile there was no statistically significant difference in the risk of developing thromboembolic events (OR, 1.64 (95% CI, 0.39-6.97); p = 0.5). Topical administration of TXA could significantly reduce total blood loss and transfusion requirements in primary THA, without increased thromboembolic complications.

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Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

Cited by 11 publications

References 38 publications

Effectiveness and Safety of Tranexamic Acid for Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Effectiveness and Safety of Tranexamic Acid for Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

The antifibrinolytic and anti‐inflammatory effects of multiple doses of oral tranexamic acid in total knee arthroplasty patients: a randomized controlled trial

Topical administration of tranexamic acid in total hip arthroplasty: A meta-analysis of Randomized Controlled Trials

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