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:10.1097/01.sa.0000490916.35801.63

Cited by 7 publications

(9 citation statements)

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“…Blood loss estimation formulae try to solve the need for reliable quantification . Given that there is no gold‐standard method of blood loss quantification, blood loss estimation formulae have been considered valid approximations for the evaluation of the efficacy of pharmacological interventions, topical hemostatic agents, and surgical techniques . In fact, estimations obtained by these formulae have been widely used to obtain important clinical conclusions, even when formulae and direct measurement of blood loss showed no agreement .…”

Section: Discussionmentioning

confidence: 99%

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Agreement of surgical blood loss estimation methods

et al. 2018

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BACKGROUND Surgical blood loss is usually estimated by different formulae in studies of strategies aimed at reducing perioperative bleeding. This study assessed and compared the agreement of the main blood loss estimation formulae using a direct measurement of blood loss as the reference method. STUDY DESIGN AND METHODS Eighty consecutive patients undergoing urologic laparoscopic surgery were studied. Only optimal conditions for the direct measurement of surgical blood loss were considered. Surgical blood loss was estimated by six formulae at four different postoperative time points. The agreement of the formulae was evaluated by the Concordance correlation coefficient (CCC) and Bland–Altman analyses. An analysis of the agreement's variability regarding different magnitudes of blood loss was also performed. RESULTS Directly measured blood loss ranged from 200 to 2200 mL. The formulae studied showed poor agreement with the direct measurement of blood loss; 95% limits of agreement widely exceeded the criterion of ±560 mL. Significant biases were found, which for most of the formulae led to an overestimation of blood loss. For all formulae, agreement remained constant regardless of the amount of blood loss, with limits between −40 and +120% approximately. Among the formulae, the best agreement was achieved by López‐Picado's formula at 48 hours (CCC: 0.577), with a bias of +283 mL and 95% limits of agreement between −477 and +1043 mL. CONCLUSION Formulae currently used to estimate surgical blood loss differ substantially from direct measurements; therefore, they may not be reliable methods of blood loss quantification in the surgical setting.

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Section: Discussionmentioning

confidence: 99%

“…Although it has been suggested that formulae may be significantly inexact and different from each other, their actual agreement has not been properly investigated and compared. As a result, many blood loss estimation formulae are still being used in several clinical trials as valid methods of quantification …”

Section: Introductionmentioning

confidence: 99%

Agreement of surgical blood loss estimation methods

et al. 2018

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“…There was not any significant difference between one dose and two doses of TXA groups. In all groups, D-dimer levels were increased in 1st and 6th hours, but D-dimer levels were higher in control group than TXA groups [11] .…”

Section: Editorialmentioning

confidence: 75%

The Safety Of Tranexamic Acid In Total Joint Arthroplasty

Aslan¹,

Çelebi²,

Çıtlak³

2020

International Journal of Orthopaedics

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“…The efficacy of TXA in reducing blood loss and transfusion in THA patients has been reported in several studies [2,18]. However, intravenous administration of EPI in joint replacement patients is a matter of debate, owing to the risk of thrombosis [19,20].…”

Section: Discussionmentioning

confidence: 99%

Effects of low‐dose epinephrine on perioperative hemostasis and inflammatory reaction in major surgical operations: a randomized clinical trial

Liu

Zeng

Wang

et al. 2018

Journal of Thrombosis and Haemostasis

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Essentials• Blood loss and immune reaction are closely related to morbidity and recovery after surgery.• We studied the effect of epinephrine plus tranexamic acid on blood loss and immune reaction.• Epinephrine plus tranexamic acid reduced postoperative total blood loss and immune reaction.• Epinephrine plus tranexamic acid did not increase the incidence of complications.Summary. Background: Hemostasis, thrombosis and surgical stress-induced immune reactions are important for perioperative morbidity and recovery after major surgical operations. Objectives: To evaluate the effects of combined administration of low-dose epinephrine (LDEPI) and tranexamic acid (TXA) on perioperative blood loss, thromboembolic complications and inflammatory responses in patients undergoing total hip arthroplasty (THA). Patients/Methods: Patients scheduled for THA (n = 195) were randomized into three interventions: intravenous LDEPI plus TXA (group IV); topical diluted epinephrine plus TXA (group TP); and TXA alone as control (group CT). The primary outcome was perioperative blood loss on postoperative day (POD) 1. Secondary outcomes included perioperative blood loss on POD 3, intraoperative blood loss, volume of drainage, transfusion values, coagulation and fibrinolysis parameters, inflammatory cytokine levels, cases of thrombosis, intravenous fluid on the operation day, and length of hospital stay. Results: The mean calculated amounts of total blood loss in groups IV, TP and CT were 631.2 mL, 760.5 mL, and 825.6 mL, respectively, on POD 1; treatment effects (differences) were 194.4 mL (95% confidence interval [CI] 146.7-242.0) and 65.0 mL (95% CI 17.4-112.7). Groups IV and TP had lower levels of proinflammatory cytokines (tumor necrosis factor-a and interleukin [IL]-1b) and higher levels of the anti-inflammatory cytokine IL-10, and showed faster development of coagulation and fibrinolysis (without change in peak levels), than group CT early postoperation. No differences were observed in transfusion, thromboembolic and other outcomes among the groups. Conclusion: The combined administration of LDEPI and TXA was more effective in reducing perioperative blood loss and alleviating the inflammatory response than TXA alone, without increasing the incidence of thromboembolic and other complications.

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

Cited by 7 publications

References 0 publications

Agreement of surgical blood loss estimation methods

Agreement of surgical blood loss estimation methods

The Safety Of Tranexamic Acid In Total Joint Arthroplasty

Effects of low‐dose epinephrine on perioperative hemostasis and inflammatory reaction in major surgical operations: a randomized clinical trial

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