Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement

Good, Lars; Peterson, Edward L.; Lisander, Björn

doi:10.1093/bja/aeg111

Cited by 390 publications

(313 citation statements)

References 14 publications

Supporting

Mentioning

288

Contrasting

Unclassified

Order By: Relevance

“…One study suggested the latter method is more accurate because the hemoglobin concentration of drains can be variable and because hidden surgical blood loss and intraoperative blood loss should be accounted for [12]. The combined results with both parameters showed the POIO and POIOPO groups had reduced blood loss as compared with the control group.…”

Section: Discussionmentioning

confidence: 99%

“…One was the drain loss which was the sum of the drain collection on Day 1 (Day 1 drain loss) and on Day 2 (Day 2 drain loss). The other parameter was the total blood loss calculated by the hemoglobin balance method [12,19], which involved measuring hemoglobin levels at several stages. This calculation gave a better estimation of the combined external loss, ie, intraoperative loss plus drain loss and the internal (hidden) blood loss.…”

Section: Methodsmentioning

confidence: 99%

“…From these, the total blood loss in milliliters was calculated as follows [12,19]: total blood loss = 1000 * Hb loss /Hb i .…”

Section: Methodsmentioning

confidence: 99%

“…It has been used successfully to reduce the blood loss in cardiac surgery [22], liver surgery [4], and gynecology [30]. The efficacy of tranexamic acid administered intravenously in preventing blood loss in TKA has been established in numerous studies [2,6,[12][13][14][15]29]. Topical application of tranexamic acid intraoperatively has shown a decrease in blood loss after TKA without the disadvantage of systemic absorption and thromboembolic complications [31].…”

Section: Introductionmentioning

confidence: 99%

“…A literature review shows studies where tranexamic acid was administered either as a single dose just before the release of the tourniquet [1,13] or along with an additional postoperative dose [2,6,12,14,32]. Inflation of the tourniquet stimulates the fibrinolytic system; administrating tranexamic acid before tourniquet inflation was studied by Tanaka et al [29] and Jansen et al [15].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Maniar

Kumar²,

Singhi

et al. 2012

Clinical Orthopaedics &Amp; Related Research

277

256

View full text Add to dashboard Cite

Background The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. Questions/purposes We studied different dosages, timings, and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA. Methods We prospectively studied five regimens (four intravenous, one local; 40 patients each) with a control group (no tranexamic acid). The four intravenous (10-mg/kg dose) regimens included (1) intraoperative dose (IO) given before tourniquet deflation, (2) additional preoperative dose (POIO), (3) additional postoperative dose (IOPO), and (4) all three doses (POIOPO). The fifth regimen was a single local application (LA). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method, were evaluated statistically. Results Both parameters were reduced in all five regimens as against the control. A significant reduction in drain loss was seen in the POIO, IOPO, and POIOPO groups whereas total blood loss was significantly reduced in the POIO, POIOPO, and LA groups. The POIOPO group had the least drain loss (303 mL) and least total blood loss (688 mL). The IO group had the greatest drain loss and the IOPO group the greatest total blood loss. Conclusions Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…From these, the total blood loss in milliliters was calculated as follows [12,19]: total blood loss = 1000 * Hb loss /Hb i .…”

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Maniar

Kumar²,

Singhi

et al. 2012

Clinical Orthopaedics &Amp; Related Research

277

256

View full text Add to dashboard Cite

show abstract

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

View full text Add to dashboard Cite

IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

show abstract

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Henry

Carless

Moxey

et al. 2007

Cochrane Database of Systematic Reviews

287

235

View full text Add to dashboard Cite

BackgroundConcerns regarding the safety of transfused blood have led to the development of a range of interventions to minimise blood loss during major surgery. Anti-fibrinolytic drugs are widely used, particularly in cardiac surgery, and previous reviews have found them to be effective in reducing blood loss, the need for transfusion, and the need for re-operation due to continued or recurrent bleeding. In the last few years questions have been raised regarding the comparative performance of the drugs. The safety of the most popular agent, aprotinin, has been challenged, and it was withdrawn from world markets in May 2008 because of concerns that it increased the risk of cardiovascular complications and death. ObjectivesTo assess the comparative effects of the anti-fibrinolytic drugs aprotinin, tranexamic acid (TXA), and epsilon aminocaproic acid (EACA) on blood loss during surgery, the need for red blood cell (RBC) transfusion, and adverse events, particularly vascular occlusion, renal dysfunction, and death.

show abstract

Tranexamic acid decreases external blood loss but not hidden blood loss in total knee replacement

Abstract: Tranexamic acid decreased total blood loss by nearly 30%, drainage volume by approximately 50% and drastically reduced transfusion. However, concealed loss was only marginally influenced by tranexamic acid and was at least as large as the drainage volume.

Cited by 390 publications

References 14 publications

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Anti-fibrinolytic use for minimising perioperative allogeneic blood transfusion

Contact Info

Product

Resources

About