Tranexamic acid in total hip arthroplasty saves blood and money

Johansson, Torsten; Pettersson, Lars-Göran; Lisander, Björn

doi:10.1080/00016470510030751

Cited by 201 publications

(167 citation statements)

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“…We considered this reduction clinically relevant. The effect size was based on blood loss and transfusion requirements in two earlier studies [3,15]. In a prospective controlled study on patients who had THAs, Johansson et al [15], found a 27% reduction in total blood loss (355 mL) reduced (p = 0.009) the number of patients who had transfusions.…”

Section: Methodsmentioning

confidence: 99%

“…The effect size was based on blood loss and transfusion requirements in two earlier studies [3,15]. In a prospective controlled study on patients who had THAs, Johansson et al [15], found a 27% reduction in total blood loss (355 mL) reduced (p = 0.009) the number of patients who had transfusions. In a retrospective study [3], we found a 30% reduction in total blood loss (370 mL) reduced (p = 0.006) the number of patients who received transfusions by 28%.…”

Section: Methodsmentioning

confidence: 99%

“…We performed a power analysis based on two earlier studies in which a significant reduction in the number of patients who had transfusions showed a 30% reduction in total blood loss [3,15]. We considered this reduction clinically relevant.…”

Section: Methodsmentioning

confidence: 99%

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Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Borgen

Dahl

Reikerås

2012

Clinical Orthopaedics &Amp; Related Research

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Background Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points. Questions/purposes We therefore asked whether there are differences in blood loss, transfusion requirements, and other postoperative clinical complications with preoperative versus postoperative start of thromboprophylaxis with dalteparin. Methods In a double-blind, randomized controlled trial, 80 patients undergoing primary cemented THA were allocated to dalteparin injections starting 12 hours before or 6 hours after surgery. Blood loss was measured by weighing sponges and drapes, volume in suction drains during surgery, and wound drains until removal 24 hours postoperatively. Hemoglobin and hematocrit were recorded at predefined times during and after surgery. Results We found no differences in blood loss (1081 mL ± 424 mL versus 1023 mL ± 238 mL), bleeding-related events (10% versus 17%), or number of patients who had transfusions (12 versus five) with preoperative and postoperative thromboprophylaxis, respectively. Other complications were few in both groups. Conclusions Our data suggest blood loss is similar with preoperative and postoperative initiation of dalteparin thromboprophylaxis, but indicate a trend toward fewer transfusion requirements which might favor postoperative start of thromboprophylaxis.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Borgen

Dahl

Reikerås

2012

Clinical Orthopaedics &Amp; Related Research

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“…The rationale for AKI = acute kidney injury; DVT = deep vein thrombosis; Hb = hemoglobin concentration; MI = myocardial infarction; PE = pulmonary embolism; RBC = red blood cells; THA = total hip arthroplasty; TKA = total knee arthroplasty; TXA = tranexamic acid utilizing the TXA dose was established independently in 2012 prior to initiation of the protocol following an extensive review of available literature by the Pharmacy and Therapeutics Committee. [2][3][4][5][6][9][10][11][14][15][16][17] It was determined that, from the highly variable dosing reported, this 20 mgÁkg -1 dose provided a balance between reducing perioperative blood loss and RBC transfusion while limiting the incidence of potential adverse events. Nevertheless, this study did not incorporate a well-defined a priori standardized intraoperative fluid management strategy with strictly defined transfusion triggers, which limited the interpretation of our data.…”

Section: Discussionmentioning

confidence: 99%

“…Méthode Nous avons mis en oeuvre une politique de qualité des soins afin de procéder à l'administration universelle de TXA par voie intraveineuse à une dose de 20 mgÁkg -1 à tous les patients admissibles subissant une arthroplastie totale de la hanche ou du genou entre le 21 Administration of tranexamic acid (TXA) has been shown to reduce blood loss and allogeneic red blood cell (RBC) transfusion in cardiac and various noncardiac surgical procedures. 1 Many randomized controlled trials, [2][3][4][5][6] systematic reviews, and meta-analyses [7][8][9][10][11] have shown that systemic and topically administered TXA reduces allogeneic RBC transfusion in hip or knee arthroplasty surgery. Recent observational studies have also shown an association between TXA use and reduced RBC transfusion.…”

Section: Résuméunclassified

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

Baker

Pavenski

Pirani

et al. 2015

Can J Anesth/J Can Anesth

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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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...

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Tranexamic acid in total hip arthroplasty saves blood and money

Abstract: Considering the cost of blood and tranexamic acid only, use of the drug would save EUR 47 Euro per patient. We recommend a preoperative single dose of tranexamic acid for standard use in THA.

Cited by 201 publications

References 10 publications

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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