Topical Tranexamic Acid versus Autotransfusion after Total Knee Arthroplasty

Güzel, Yunus; Gurcan, Osman T; Gölge, Umut Hatay; Dülgeroğlu, Turan Cihan; Metineren, Hasan

doi:10.1177/1602400212

Cited by 14 publications

(7 citation statements)

References 27 publications

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“…ATEs were rarely reported as a complication in the randomized clinical trials. After the quality assessment, 9 randomized clinical trials encompassing 817 patients were available for the metaanalysis (Table 2) [16,30,37,38,65,67,68,90,93]. Published randomized clinical trials included comparisons between placebo and IV, topical, oral, or combined IV/oral TXA.…”

Section: Meta-analysis Of Atesmentioning

confidence: 99%

The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis

Fillingham

Ramkumar

Jevsevar

et al. 2018

The Journal of Arthroplasty

127

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Although most studies included in our analysis excluded patients with a history of prior thromboembolic events, our findings support the lack of evidence of harm from TXA administration in patients undergoing TJA. Moderate evidence supports the safety of TXA in patients undergoing total knee arthroplasty with an ASA score of 3 or greater. The benefits of using TXA appear to outweigh the potential risks of thromboembolic events even in patients with a higher comorbidity.

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Section: Meta-analysis Of Atesmentioning

confidence: 99%

The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis

Fillingham

Ramkumar

Jevsevar

et al. 2018

The Journal of Arthroplasty

127

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“…Topical TXA application during arthroplasty may be a safer route than the systemic method, which may reduce postoperative haemorrhage without causing hypercoagulation. Notably, the topical route has been shown to be a cost-effective and convenient route for TXA administration during dental, cardiac and spinal surgeries 25. Several relevant trials have been published recently.…”

Section: Introductionmentioning

confidence: 99%

Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials

Sun

Chen

et al. 2019

BMJ Open

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ObjectiveThis study aimed to compare the effects of intravenous, topical and combined routes of tranexamic acid (TXA) administration on blood loss and transfusion requirements in patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA).DesignThis was a meta-analysis of randomised controlled trials (RCT) wherein the weighted mean difference (WMD) and relative risk (RR) were used for data synthesis applied in the random effects model. Stratified analyses based on the surgery type, region, intravenous and topical TXA dose and transfusion protocol were also conducted. The main outcomes included intraoperative and total blood loss volume, transfusion rate, low postoperative haemoglobin (Hb) level and postoperative Hb decline. However, the secondary outcomes included length of hospital stay (LOS) and/or occurrence of venous thromboembolism (VTE).SettingWe searched the PubMed, Embase and Cochrane CENTRAL databases for RCTs that compared different routes of TXA administration.ParticipantsPatients undergoing TKA or THA.InterventionsIntravenous, topical or combined intravenous and topical TXA.ResultsTwenty-six RCTs were selected, and the intravenous route did not differ substantially from the topical route with respect to the total blood loss volume (WMD=30.92, p=0.31), drain blood loss (WMD=−34.53, p=0.50), postoperative Hb levels (WMD=−0.01, p=0.96), Hb decline (WMD=−0.39, p=0.08), LOS (WMD=0.15, p=0.38), transfusion rate (RR=1.08, p=0.75) and VTE occurrence (RR=1.89, p=0.15). Compared with the combined-delivery group, the single-route group had significantly increased total blood loss volume (WMD=198.07, p<0.05), greater Hb decline (WMD=0.56, p<0.05) and higher transfusion rates (RR=2.51, p<0.05). However, no significant difference was noted in the drain blood loss, postoperative Hb levels and VTE events between the two groups. The intravenous and topical routes had comparable efficacy and safety profiles.ConclusionsThe combination of intravenous and topical TXA was relatively more effective in controlling bleeding without increased risk of VTE.

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“…For this reason, blood management using iron supplements and/or EPO and/or anti-fibrinolytics should be considered when planning the treatment strategy for hip fracture patients with several risk factors for ABT. [ 30 , 32 , 35 ]…”

Section: Discussionmentioning

confidence: 99%

Allogeneic red blood cell transfusion is an independent risk factor for 1-year mortality in elderly patients undergoing femoral neck fracture surgery

et al. 2020

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Allogeneic red blood cell transfusion (ABT) is 1 of the poor prognostic factors for morbidity and mortality in patients with hip fracture, particularly among elderly patients. This study aimed to investigate the risk factors for ABT and 1-year mortality in elderly patients undergoing surgery for femoral neck fracture. A total of 225 elderly patients who underwent femoral neck fracture surgery between May 2013 and November 2015 at a tertiary medical center were retrospectively recruited. Medical records were analyzed. The median patient age was 80 years and 28.4% were men. A total of 113 patients received ABT (50.2%). Multivariate logistic regression analysis showed that female sex (odds ratio [OR] 2.606, 95% confidence interval [CI] 1.283–5.295, P = .008), malignancy (OR 5.098, 95% CI 1.725–15.061, P = .003), chronic kidney disease stage ≥ 3 (OR 3.258, 95% CI 1.603–6.622, P = .001), and anemia (hemoglobin < 12 g/dL) (OR 4.684, 95% CI 2.230–9.837, P < .001) were significantly associated with ABT. The 1-year mortality rate after surgery was 15.1%. Male sex (OR 2.477, 95% CI 1.101–5.575, P = .028), ABT (OR 2.367, 95% CI 1.036–5.410, P = .041), and intensive care unit admission (OR 5.564, 95% CI 1.457–21.249, P = .012) were significantly associated with 1-year mortality. In this study, underlying comorbidities such as chronic kidney disease and malignancy were associated with ABT. Furthermore, ABT was a significant independent risk factor for 1-year mortality. These findings suggest that underlying comorbidities and the need for ABT should be considered in the risk assessment of elderly patients with femoral neck fracture to improve the outcomes after surgery.

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Topical Tranexamic Acid versus Autotransfusion after Total Knee Arthroplasty

Abstract: Compared with PAT, topical TXA was more cost-effective and resulted in less total postoperative drainage volume and less need for allogeneic blood transfusion.

Cited by 14 publications

References 27 publications

The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis

The Safety of Tranexamic Acid in Total Joint Arthroplasty: A Direct Meta-Analysis

Comparison of intravenous, topical or combined routes of tranexamic acid administration in patients undergoing total knee and hip arthroplasty: a meta-analysis of randomised controlled trials

Allogeneic red blood cell transfusion is an independent risk factor for 1-year mortality in elderly patients undergoing femoral neck fracture surgery

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