Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage: current evidence

Kim, Christopher; Park, Sam Si-Hyeong; Davey, J. Roderick

doi:10.2147/jbm.s61915

Cited by 41 publications

(21 citation statements)

References 40 publications

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“…Addressing post-operative anemia with blood transfusion carries health and cost implications for both patients and doctors. 27 TA was introduced with the aim of reducing post-operative bleeding and the need for blood transfusion following TJA.…”

Section: Results Of Meta-analysismentioning

confidence: 99%

“…Since the first report of its IV administration during TKA back in 1997, 13 the use of TA in TJA has been become well established in the literature. 27 It is now widely accepted that IV administration of TA reduces blood loss and the need for transfusion without a significant increase in the rate of adverse events following THA. 16 , 27 However, concerns remain regarding the risk of DVT and PE associated with IV administration.…”

Section: Results Of Meta-analysismentioning

confidence: 99%

“… 27 It is now widely accepted that IV administration of TA reduces blood loss and the need for transfusion without a significant increase in the rate of adverse events following THA. 16 , 27 However, concerns remain regarding the risk of DVT and PE associated with IV administration. In addition, some authors believe that the systemic use of TA results in its distribution throughout the whole circulating volume thus reducing its therapeutic concentration at the operative field.…”

Section: Results Of Meta-analysismentioning

confidence: 99%

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Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

2016

Orthop Rev

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Tranexamic acid (TA) is widely used by orthopedic surgeons to decrease blood loss and the need for transfusion following total hip arthroplasty (THA). Although both intravenous and topical applications are described in the literature, there remains no consensus regarding the optimal regimen, dosage and method of delivery of TA during THA. In addition, concerns still exist regarding the risk of thromboembolic events with intravenous administration. The purpose of this meta-analysis was to compare the efficacy and safety of topical versus intravenous administration of TA in THA. A systemic review of the electronic databases PubMed, CENTRAL, EMBASE and Google Scholar was undertaken to identify all randomized controlled trials (RCTs) comparing the topical and intravenous administration of TA during THA, in terms of total blood loss, rate of blood transfusion and incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) post-operatively. A meta-analysis was performed to evaluate and compare the efficacy and safety of both methods of administration. Of 248 potentially relevant papers, three RCTs comprising (482) were eligible for data extraction and meta-analysis. The results showed a slightly higher amount of blood loss [Mean Difference (MD) – 46.37, P=0.12, 95% confidence interval (CI) – 12.54 to 105.29] and rate of transfusion (Risk Ratio 1.30, P=0.39, 95%CI 0.71 to 2.37) postoperatively in the topical TA group, but both did not reach statistical significance. There were 3 cases (1.2%) of DVT/PE in the intravenous group and one case (0.4%) in the topical group. Topical TA is an effective and safe method to reduce blood loss and the rate of transfusion following primary THA. It has comparative effectiveness to IV administration with slightly less post-operative thromboembolic complications. Larger and better-designed RCTs are required to establish the optimum dosage and regimen for topical use.

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Section: Results Of Meta-analysismentioning

confidence: 99%

Section: Results Of Meta-analysismentioning

confidence: 99%

Section: Results Of Meta-analysismentioning

confidence: 99%

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Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

2016

Orthop Rev

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“…1). As documented by several authors, the use of TXA effectively and safely reduces the amount of postoperative bleeding and the need for transfusions in primary total hip arthroplasty and revision hip arthroplasty38,39,40,41,42,43,44,45,46). However, the appropriate route (IV versus topical), correct dose and time of administration of TXA still remain unclear.…”

Section: Tranexamic Acidmentioning

confidence: 99%

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

et al. 2017

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The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.

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“…Total hip arthroplasty (THA) is one of the most common treatments in orthopedic surgery, associated with large amount of postoperative blood loss and significant rate of blood transfusion. It was estimated that the average blood loss during primary THA can be between 1000 and 2000 ml, and up to 37% of patients undergoing primary THA require blood transfusion for postoperative anemia[ 1 ]. Postoperative anemia may impede functional ability and increase the length of hospital stay and the costs.…”

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

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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.

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Tranexamic acid for the prevention and management of orthopedic surgical hemorrhage: current evidence

Cited by 41 publications

References 40 publications

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus

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

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