The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis

Fillingham, Yale A.; Ramkumar, Dipak B.; Jevsevar, David S.; Yates, Adolph J.; Shores, Peter; Mullen, Kyle; Bini, Stefano A.; Clarke, Henry D.; Schemitsch, Emil H.; Johnson, Rebecca L.; Memtsoudis, Stavros G.; Sayeed, Siraj A.; Sah, Alexander P.; Valle, Craig J. Della

doi:10.1016/j.arth.2018.04.043

Cited by 200 publications

(188 citation statements)

References 70 publications

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“…Lastly, risk factor such as perioperative tranexamic acid or anticoagulant use was not available in the NIS dataset. 29,30 This unmeasured risk factor could act as a confounder for postoperative blood transfusion. We used the approach of Lin et al for assessing the impact of this unmeasured potential confounder in sensitivity analyses.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following Revision Total Knee Arthroplasty Septic versus Aseptic Failure: A National Propensity-Score-Matched Comparison

et al. 2020

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Although periprosthetic joint infection (PJI) has been hypothesized to increase the risk of complications following revision total knee arthroplasty (TKA), strong evidence linking the two is lacking. The aim of this study was to determine whether PJI is an independent risk factor for inpatient perioperative complications, and increased resource use in patients undergoing revision TKA. We relied on the US Nationwide Inpatient Sample (NIS) to identify patients with PJI or non-PJI treated with revision TKA between 2002 and 2014. Overall, 5,316 (16.4%) and 27,033 (83.6%) patients were categorized as PJI and non-PJI, respectively. To adjust for potential baseline differences between the two groups, propensity-score-based matching was performed. This resulted in 5,187 (50%) PJI patients matched to 5,187 (50%) non-PJI patients. The rates of postoperative complications, blood transfusions, prolonged length of stay (pLOS), in-hospital cost, and in-hospital mortality were assessed for both groups. Multivariable logistic regression analyses were performed within the cohort after propensity-score matching. For PJI versus non-PJI, respectively, the following rates were recorded: blood transfusions, 28.3 versus 18.4% (p < 0.0001); postoperative complications, 27.5 versus 19.8% (p < 0.0001); pLOS (>4 d), 61.9 versus 26.9% (p < 0.0001); in-hospital cost (>$39,929), 55.8 versus 44.2% (p < 0.0001); in-hospital mortality, 0.6 versus 0.3% (p = 0.016). In multivariable logistic regression analyses, PJI patients were more likely to receive a blood transfusion (odds ratio [OR]: 1.78; p < 0.0001), to experience postoperative complications (OR: 1.56; p < 0.0001), to have a higher in-hospital cost (OR: 1.65; p < 0.0001), to have a pLOS following surgery following surgery (OR: 4.69; p < 0.0001), and to have a higher in-hospital mortality (OR: 2.14; p = 0.019). After adjustment for potential selection biases, PJI is associated with more adverse perioperative outcomes and resource use than non-PJI patients. This is a Level II (level of evidence), prognostic study.

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Section: Discussionmentioning

confidence: 99%

Outcomes following Revision Total Knee Arthroplasty Septic versus Aseptic Failure: A National Propensity-Score-Matched Comparison

et al. 2020

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“…TXA has gradually become a routine part of perioperative care in primary total arthroplasty of the hips and knees 5,6 . Therefore, the clinical utility of this intervention is unquestionable and is supported by several meta-analyses of RCTs (randomized clinical trials) for primary hips and knees [7][8][9][10][11] .…”

Section: Introductionmentioning

confidence: 99%

Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid

Lošťák¹,

Gallo²,

Slavík³

et al. 2020

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. Methods. In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). Results. Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). Conclusion. The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.

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“…[2][3][4] Perioperative advances including the use of tranexamic acid to decrease blood loss, raising the transfusion criteria, and avoiding the use of Foley catheters have further decreased the need for prolonged hospitals stays. [5][6][7] Within the last 10 years, implementation of bundled payment initiatives has placed an emphasis on decreasing the use of costly acute hospital resources as well as postacute rehabilitation and skilled nursing stays. 8 All of these factors have contributed to the rise in same-day and next-day discharge of TKA patients to home.…”

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confidence: 99%

Inpatient versus Outpatient Total Knee Arthroplasty

et al. 2019

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The rise of improved perioperative recovery protocols after total knee arthroplasty (TKA) has led to faster, more streamlined hospital stays for many patients. Combined with the implementation of value-based care and bundled payment initiatives, there has been a paradigm shift toward outpatient TKA surgery. This change to practice has been accelerated by recent policy changes enacted by the Center for Medicaid and Medicare Services regarding the removal of TKA as an inpatient only procedure as well as some insurance companies denying preauthorization for inpatient stays after TKA. Our review aims to address the inclusion and exclusion criteria for outpatient TKA consideration, examine the outcomes for outpatient joint replacement surgery, and discuss limitations of widespread adoption for same-day discharges.

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The Efficacy of Tranexamic Acid in Total Knee Arthroplasty: A Network Meta-Analysis

Cited by 200 publications

References 70 publications

Outcomes following Revision Total Knee Arthroplasty Septic versus Aseptic Failure: A National Propensity-Score-Matched Comparison

Outcomes following Revision Total Knee Arthroplasty Septic versus Aseptic Failure: A National Propensity-Score-Matched Comparison

Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid

Inpatient versus Outpatient Total Knee Arthroplasty

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