Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

Whiting, Daniel R.; Duncan, Christopher M.; Sierra, Rafael J.; Smith, Hugh M.

doi:10.1016/j.arth.2015.05.050

Cited by 41 publications

(20 citation statements)

References 29 publications

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“…A recent meta-analysis showed IV TXA was effective in reducing allogenic blood transfusion by 50% and limiting blood loss intraoperatively and through drains in patients undergoing primary THA [27]. Whiting et al [43] recently reported that TXA may be beneficial in patients undergoing total joint arthroplasty regardless of preoperative Hgb, with patients with anemia still seeing transfusion reductions. Similar findings also were reported by Phan et al [35] who found no difference in the risk of transfusion between patients with anemia (Hgb\12 g/dL) versus those without anemia undergoing THA and receiving TXA.…”

Section: Discussionmentioning

confidence: 99%

What Should Define Preoperative Anemia in Primary THA?

Klement

Peres-da-Silva

Nickel

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Section: Discussionmentioning

confidence: 99%

What Should Define Preoperative Anemia in Primary THA?

Klement

Peres-da-Silva

Nickel

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…3,4,8,11,15,19,20 TXA has been shown to reduce blood loss and transfusion rates after TKA 1,3,5,9,12 as well as in other surgical procedures such as rhinoplasty. 21 The use of TXA was shown not to cause any extra complication such as thromboembolic events and renal dysfunction in a study using the data of 872,416 patients, 19 and it was also reported to be safe for patients with severe comorbidities in elective arthroplasty surgeries.…”

Section: Discussionmentioning

confidence: 99%

“…7 TXA has been shown to reduce transfusion rates in patients with a haemoglobin level higher than 15 g/dl, so it should be considered in all total joint arthroplasty patients independent of preoperative haemoglobin level. 8 Despite an increased drug cost with the use of TXA in healthy patients, concomitant reductions in operating room, blood/laboratory and room costs have been shown to contribute to nearly $900 (USA Dollar) cost savings. 22 TXA has been in routine use in total joint arthroplasty during the last decade with the benefits of decreasing blood loss, transfusion rates and hospital costs without any increase in complication rates.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Recent randomized controlled trials (RCTs) have proved that tranexamic acid (TXA) reduces blood loss and transfusion rates after TKA, and TXA is routinely used in TKA following the publication of studies with excellent results. 2,3,5,6 TXA has been shown to be safe in patients with severe comorbidities 7 and to be beneficial regardless of preoperative haemoglobin (Hgb) value 8 in total joint arthroplasties. In respect of the single use of TXA, topical TXA has been reported to be safe 1,9,10 and as equally effective as the IV (intravenous) regimen 1,4,11 in TKA.…”

Section: Introductionmentioning

confidence: 99%

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The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

Çankaya

Daşar

Satilmis

et al. 2017

J Orthop Surg (Hong Kong)

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Aims: The combined (IV (intravenous) þ topical) use of tranexamic acid (TXA) has been shown to be a safe method and more effective than single (IV or topical) application. The optimal administration method of TXA is still being investigated and safety, efficiency and cost are the three main crucial parameters in achieving the best administration method. We aimed to determine whether combined (oral þ topical) use of TXA reduced blood loss and transfusion rates more than single (topical) administration in TKA and whether oral þ topical use is as safe and efficient as the IV þ topical use, in addition to the main advantage of relatively low cost. Methods: In this prospective, randomized study, 100 patients were randomly assigned to either the topical TXA group or the combined (oral þ topical) TXA group. There were no significant differences between the groups in age, body mass index or gender. The haemoglobin and haematocrit levels of each patient were recorded preoperatively and on post-operative days 0, 1, 2 and 3. The post-operative suction drainage and blood transfusion volumes were also recorded. Results: There were statistically significant differences between the groups in haemoglobin and haematocrit levels on post-operative days 0, 1, 2 and 3 (p < 0.05) in favour of the combined group. The post-operative drainage amounts (p ¼ 0.0001), measured blood loss volume (p ¼ 0.003) and transfusion rates (p ¼ 0.03) were lower in the combined (oral þ topical) group compared to the topical group. Conclusions: Of the different methods of TXA administration, the combined use of oral and topical TXA is a safe, efficient and low-cost method in reducing blood loss and transfusion rates after TKA.

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“…However, nowadays the specific method is likely to be used under certain circumstances. 35 Intraoperative administration of TXA has been shown to be a method of blood loss reduction during TKR, as well as reducing allogeneic transfusion even in anemic patients. We first mentioned that TXA was associated with a low risk of symptomatic thromboembolic events when used with three different chemical prophylactic regimens after routine primary TKA.…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement

et al. 2018

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Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was given preoperatively. Patients of Group C (n 3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly, in Group D (n 4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative and discharge hemoglobin together with total units of blood transfusion and creatinine levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82 units/patient, p < 0.001, CI 95%) in contrast to the two regimens of erythropoietin (1.16 units/patient) OrthoPAT (1.43 units/patient) and restrictive strategies (1.92 units/patient). The mean preoperative hemoglobin was 13.37 g/dL with no statistical difference among the groups of patients. The postoperative mean hemoglobin was 10.59 with no statistical difference among the groups of patients too. Additionally, the mean creatinine level was 0.93 mg/dL; however, no statistical difference among the groups of patients was noted. Finally, tranexamic acid seemed to be the most cost-effective regime. In our study, tranexamic acid proved its superiority concerning the postoperative blood transfusion on patients undergoing total knee replacement, in comparison with the other existing methods of perioperative blood management. This is a Level III, retrospective comparative study.

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Tranexamic Acid Benefits Total Joint Arthroplasty Patients Regardless of Preoperative Hemoglobin Value

Cited by 41 publications

References 29 publications

What Should Define Preoperative Anemia in Primary THA?

What Should Define Preoperative Anemia in Primary THA?

The combined use of oral and topical tranexamic acid is a safe, efficient and low-cost method in reducing blood loss and transfusion rates in total knee arthroplasty

A Retrospective Comparative Study of Different Methods of Blood Management in Total Knee Replacement

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