Tranexamic Acid Compared with Placebo for Reducing Total Blood Loss in Hip Replacement Surgery

Barrachina, Borja; López-Picado, Amanda; Remon, Maria; Fondarella, Ana; Iriarte, I.; Bastida, Rebeca; Rodríguez-Gascón, Alicia; Achaerandio, Maria Aranzazu; Iturricastillo, Maria Carmen; Aizpuru, Felipe; Valero, Cesar Augusto; Tobalina, Ricardo; Hernanz, Roberto

doi:10.1213/ane.0000000000001159

Cited by 57 publications

(22 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The protective role of TXA to reverse hyperfibrinolysis in trauma is suggested by a retrospective analysis of TXA use in severely injured patients in which patients in shock benefited from this medication (7), a risk factor for hyperfibrinolysis(1). TXA in elective cardiac (8) and orthopedic(9) surgery has also been associated with a reduction in blood product transfusion.…”

Section: Introductionmentioning

confidence: 99%

Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis

Moore

Huebner

et al. 2017

Journal of Surgical Research

View full text Add to dashboard Cite

Introduction Tranexamic acid (TXA) administration following trauma has not been proven to improve survival in the US. Trauma patients present to the hospital with a spectrum of fibrinolytic activity, in which a physiologic levels of fibrinolysis are associated with the lowest mortality. We hypothesize that trauma patients who present to the hospital with physiologic levels of fibrinolysis will have increased mortality if they receive TXA. Material and Methods Severely injured trauma patients followed prospectively from 2014 to 2016 we included in the analysis. The patient’s first thrombelastography (TEG) was used to stratify patients into fibrinolysis phenotypes which included fibrinolysis shutdown, physiologic fibrinolysis, and systemic hyperfibrinolysis. The primary outcome was in hospital mortality. Results 232 patients were analyzed (11% received TXA) with an overall mortality rate of 20%. TXA administration was associated with a higher new injury severity score (NISS 49 vs 28 p=0.001) massive transfusion rate (69% vs 12% p<0.001) and mortality (52% vs 17% p<0.001). Hyperfibrinolysis and shutdown had higher mortality rates than physiologic (24% vs 30% vs 14% p=0.050). The effect of TXA within phenotypes, was not significant for shutdown (28% vs 38% p=0.604) but was significant in the physiologic group (11% vs 63% p<0.001) and systemic hyperfibrinolysis (19% vs 55% p=0.023). After adjusting for NISS, TXA remained a significant predictor of mortality for patients with physiologic fibrinolysis (p=0.018). Conclusion There was no clear benefit of receiving TXA in this study, and patients who present to the hospital with physiologic levels of fibrinolysis, who received TXA, had the highest mortality. The role of TXA in mature trauma systems remains unclear, and emerging data supports it may have adverse effects.

show abstract

Section: Introductionmentioning

confidence: 99%

Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis

Moore

Huebner

et al. 2017

Journal of Surgical Research

View full text Add to dashboard Cite

show abstract

“…Twenty-one studies compared two interventions: 9 IV single vs placebo[ 21 – 29 ], 8 IV multiple vs placebo[ 17 , 30 – 36 ], 3 compared topical application vs placebo[ 37 – 39 ], and 1 IV multiple vs topical. [ 40 ] Four studies had three comparative groups: IV single vs IV multiple vs placebo[ 41 ], IV single vs topical vs placebo[ 18 ], IV single vs combined vs placebo[ 19 ], and IV single vs topical vs combined. [ 20 ] A summary of the studies from a primary search of the databases to final inclusion or exclusion is displayed in the flowchart ( Fig 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Eighteen trials[ 17 – 21 , 23 , 24 , 27 , 29 – 32 , 35 – 38 , 40 , 41 ] involving a total of 1799 patients reported data for total blood loss. All interventions significantly reduced total blood loss compared with placebo; however, no difference was observed across the four non-placebo interventions ( Fig 3B ).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

Yoon

Kim

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundTranexamic acid (TXA) has been demonstrated to minimize blood loss after total hip arthroplasty. There are three main routes: intravenous (IV), intra-articular (topical), and combined (IV and topical) but little consensus support which is most effective and safe. We performed network meta-analysis.to assess the comparative efficacy and safety of three different administration routes of TXA.MethodsTwenty-five randomized controlled trials (RCT) were evaluated. Interventions were classified as: combined, IV multiple, IV single, topical and placebo. The primary outcome was effectiveness (transfusion rate, total blood loss, and total drain out). The secondary outcome was safety, based on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).ResultsA total of 2227 patients were included in the 5 categories: 564 IV single, 319 IV multiple, 398 topical, 120 combined, and 826 placebo. A network meta-analysis identified the most effective interventions in terms of reducing the need for transfusion as follows: combined = 98.2%, IV single = 54.0%, IV multiple = 78.6%, topical = 66.1%, placebo = 0.0%. Compared with placebo, the IV single, IV multiple, topical, and combined interventions showed no difference in the rate of occurrence of DVT and PE.ConclusionsA network meta-analysis indicated that combined administration of TXA (IV and topical) was effective in reducing the transfusion rate after hip arthroplasty compared with IV or topical alone. As no high-risk patients were evaluated in the RCTs, it is not known whether the combined method is safer for patients susceptible to DVT or PE.

show abstract

“…Tranexamic acid (TXA), an antifibrinolytic drug which blocks the lysine blinding sites on plasminogen molecules and inhibits the formation of plasmin, has been widely used currently[ 3 ]. A large amount of evidences provided by prospective randomized controlled trials[ 4 , 5 ] and meta-analysis studies[ 6 , 7 ] have shown that TXA, applied either intravenously or locally, can reduce blood loss and subsequent transfusion without risking a high complication rate. Theoretically, a topical application of TXA may limit systemic absorption and decrease the risk of postoperative thromboembolic complications.…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis comparing combined intravenous and topical tranexamic acid with intravenous administration alone in THA

Sun

Jiang

2017

PLoS ONE

View full text Add to dashboard Cite

PurposeTo compare the effectiveness and safety of combined intravenous and topical tranexamic acid with intravenous use alone in THA.MethodsThe electronic databases MEDLINE, EMBASE, BIOSIS, Cochrane central, and further adapted for Google and Google Scholar internet, last updated on Dec 30, 2016, were searched. Evaluated outcomes included total blood loss, transfusion rate, maximum postoperative Hb drop, and incidence of thromboembolic complications. The standard mean difference (SMD) or the relative risk (RR) was calculated for continuous or dichotomous data respectively. The quality of the trial was assessed, and meta-analyses were performed with the Cochrane Collaboration’s RevMan 5.0 software.ResultsFive RCTs with 457 patients were included. Combined TXA administration reduced blood loss (SMD, 1.39; 95%CI, 0.55 to 2.23; P<0.00001, I2 = 94%), hemoglobin decline (SMD, 0.84; 95%CI, 0.13 to 1.54; P = 0.01, I2 = 83%) and the need for transfusion (RR, 2.58; 95%CI, 1.59 to 4.18; P = 0.65, I2 = 0%) without increasing the rate of thromboembolic complications significantly (RR, 0.83; 95%CI, 0.27 to 2.54; P = 0.81, I2 = 0%).ConclusionThe present study has emphasized that combined TXA administration can effectively reduce blood loss, hemoglobin decline and the need for transfusion without increasing the rate of thromboembolic complications.

show abstract

Tranexamic Acid Compared with Placebo for Reducing Total Blood Loss in Hip Replacement Surgery

Abstract: A single preoperative dose of TXA or 2 infusions of a lower dose, preoperatively and then after 3 hours after the start of surgery, resulted in lower blood loss during the first 2 days after surgery and less need for blood transfusion, with good levels of safety.

Cited by 57 publications

References 37 publications

Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis

Tranexamic acid is associated with increased mortality in patients with physiological fibrinolysis

Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

A systematic review and meta-analysis comparing combined intravenous and topical tranexamic acid with intravenous administration alone in THA

Contact Info

Product

Resources

About