The effect of oral versus intravenous tranexamic acid in reducing blood loss after primary total hip arthroplasty: A randomized clinical trial

Cao, Guorui; Huang, Zeyu; Xie, Jinwei; Huang, Qiang; Xu, Bin; Zhang, Shaoyun; Pei, Fuxing

doi:10.1016/j.thromres.2018.02.007

Cited by 33 publications

(40 citation statements)

References 30 publications

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“…Next, the six remaining studies were carefully full-textreviewed. Finally five RCTs [23][24][25][26][27] were included in the meta-analysis ( Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

“…For every bias item, the risk is presented as the percentage across all included studies, which indicates the proportion of different levels of risk of bias for each item. Among the included studies, three studies were randomized by computer-generated numbers [25][26][27], one by random number technique [24], and the remaining one did not report the method of random sequence generation [23]. Four studies conducted the concealment with sealed, opaque envelope [23][24][25][26].…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

“…Among the included studies, three studies were randomized by computer-generated numbers [25][26][27], one by random number technique [24], and the remaining one did not report the method of random sequence generation [23]. Four studies conducted the concealment with sealed, opaque envelope [23][24][25][26]. Doubleblinding was reported in all the five included studies [23][24][25][26][27].…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

“…Four studies conducted the concealment with sealed, opaque envelope [23][24][25][26]. Doubleblinding was reported in all the five included studies [23][24][25][26][27]. In four studies the outcome assessors were blinded [23][24][25][26], and in the remaining one [27], the data analyst was not blinded.…”

Section: Quality Of the Included Studiesmentioning

confidence: 99%

“…For deep vein thrombosis prophylaxis, low molecular weight heparin was used in hospital, and in the four Chinese researches, Rivaroxaban was administered after the patients were discharged. Three studies adopted multiple doses [23,26,27], and in the other two studies a single dose was applied to every patient [24,25] (Table 1). Outcomes for meta-analysis Total blood loss…”

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

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Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Wang

et al. 2020

Arthroplasty

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Background: Total hip arthroplasty is associated with substantial blood loss which can lead to postoperative anemia. The purpose of this systematic review and meta-analysis was to compare efficacy and safety of oral tranexamic acid (TXA) and intravenous TXA. Methods: PubMed, EMBASE, and Cochrane Library were searched from inception until December 2019. A combined searching strategy of subject words and random words was adopted. Only clinical randomized controlled trials were included. The comparisons were made with regard to total blood loss, hemoglobin drop, transfusion rate, and postoperative thromboembolic complications including deep vein thrombolism (DVT) and pulmonary embolism (PE). The meta-analysis was conducted by using the Review Manager 5.3, and bias evaluation was performed based on the Cochrane Handbook 5.1.0. Results: In this meta-analysis, five randomized controlled trials were included. The results showed that there were no significant differences between the oral TXA group and intravenous TXA group concerning total blood loss [mean difference (MD) =3.01, 95% confidence interval (95% CI): − 43.90 to 49.92, p = 0.90], hemoglobin drop (MD = 0.05, 95% CI: − 0.10 to 0.20, p = 0.50) and transfusion rate of allogeneic blood [risk ratio (RR) =1.09, 95% CI: 0.46 to 2.62, p = 0.84]. No significant difference was found in the incidence of thromboembolic events (RR = 1.71, 95% CI: 0.71 to 4.16, p = 0.97). Conclusions: Compared with intravenous TXA, oral TXA is equally able to reduce total blood loss, hemoglobin drop, and transfusion requirement for total hip arthroplasty. It is a lower-cost method that does not increase the incidence of thromboembolic events.

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“…Next, the six remaining studies were carefully full-textreviewed. Finally five RCTs [23][24][25][26][27] were included in the meta-analysis ( Fig. 1).…”

Section: Search Resultsmentioning

confidence: 99%

Section: Quality Of the Included Studiesmentioning

confidence: 99%

Section: Quality Of the Included Studiesmentioning

confidence: 99%

Section: Quality Of the Included Studiesmentioning

confidence: 99%

Section: General Characteristics Of Included Studiesmentioning

confidence: 99%

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Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Wang

et al. 2020

Arthroplasty

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

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Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

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The effect of oral versus intravenous tranexamic acid in reducing blood loss after primary total hip arthroplasty: A randomized clinical trial

Cited by 33 publications

References 30 publications

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

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