Tranexamic acid plus diluted-epinephrine versus tranexamic acid alone for blood loss in total joint arthroplasty

Yu, Zhanxia; Yao, Lulan; Yang, Qin

doi:10.1097/md.0000000000007095

Cited by 12 publications

(12 citation statements)

References 19 publications

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“…However, they only focused on the administration of TXA itself, but did not analysed other influencing factors. Yu et al [45] and Wu et al [46] compared tranexamic acid plus diluted-epinephrine versus tranexamic acid alone for blood loss in total joint arthroplasty, but they only retrieved several studies and only focused on blood loss and transfusion rate. As a result, whether TXA combined with anticoagulant are effective and safe enough to apply in clinical is still inconsistent.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Bo¹,

Jiang²,

Deng³

et al. 2020

Preprint

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Purpose To evaluate the efficacy and safety of tranexamic acid combined with rivaroxaban in prevention of clinical events in patients after TKA/THA through meta-analysis of randomized controlled trials. Materials and Methods RCTs were retrieved from medical literature databases. RR, SMD and 95% confidence intervals (CI) were calculated to compare the primary and safety endpoints. Results In total, 16 articles (23 trial comparisons) were retrieved which contained 2179 patients. In general, 1257 patients (57.7%) were randomized to experimental group whereas 922 patients (42.3%) were randomized to control group. The result showed that TXA combined with rivaroxaban significantly reduce TBL, BTV, BTR and the incidence of MB compared to the control group; there were no significant differences in NMB between experimental group and control group. Conclusions This meta-analysis reveals that TXA combined with rivaroxaban can significantly reduce TBL, BTV, the incidence of blood transfusion and the incidence of MB compared to the control group, which proved that its efficacy and safety are trustworthy.

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Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Bo¹,

Jiang²,

Deng³

et al. 2020

Preprint

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“…This was not the first meta-analysis. Yu et al [ 20 ] conducted a meta-analysis comparing TXA plus DEP for blood loss after total joint arthroplasty (THA and total knee arthroplasty). Thus, we could not determine whether TXA plus DEP was certain to have a significant influence on controlling blood loss among patients undergoing THA alone.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, we could not determine whether TXA plus DEP was certain to have a significant influence on controlling blood loss among patients undergoing THA alone. Moreover, Yu et al [ 20 ] only included two studies that focused on THA. In this meta-analysis, we ultimately included six studies totalling 703 patients, adding the statistical power of at least 535 cases.…”

Section: Discussionmentioning

confidence: 99%

Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

Zhao

Zhang

2018

J Orthop Surg Res

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BackgroundThe standard protocol to achieve haemostasis during total hip arthroplasty (THA) is uncertain. Tranexamic acid plus diluted epinephrine (DEP) and tranexamic acid (TXA) alone are the two most common alternatives. The purpose of this study was to compare the efficacy and safety of TXA plus DEP to treat blood loss in THA patients.MethodsPublished randomized controlled trials (RCTs) were identified from the following electronic databases: PubMed, Embase, Web of Science, Cochrane Library and Google from inception to July 10, 2018. Studies comparing TXA plus DEP with TXA alone to treat blood loss were included. Either a random-effects model or a fixed-effects model was used for meta-analysis depending on the heterogeneity. We used the need for transfusion as the primary outcome. Stata 12.0 was used for meta-analysis.ResultsSix studies involving 703 patients were included in the present meta-analysis. The pooled results demonstrated that TXA plus DEP was associated with a lower transfusion rate than TXA alone (RR = 0.57, 95% CI 0.38–0.86, P = 0.006). Furthermore, TXA plus DEP was associated with less total blood loss and hidden blood loss by approximately 209.79 ml and 297.74 ml, respectively, than TXA alone. There was no significant difference in terms of intraoperative blood loss or the occurrence of deep venous thrombosis or haematoma between the TXA plus DEP and TXA alone groups (P > 0.05).ConclusionsOur meta-analysis suggested that TXA plus DEP significantly decreased the need for transfusion, total blood loss and hidden blood loss among THA patients. Furthermore, TXA plus DEP did not increase the occurrence of DVT or haemostasis. Additional long-term follow-up RCTs are needed to identify the optimal doses of TXA and DEP.Electronic supplementary materialThe online version of this article (10.1186/s13018-018-0948-1) contains supplementary material, which is available to authorized users.

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“…A recent meta‐analysis by Yu et al . published in Medicine assessed the combined use of tranexamic acid and epinephrine in the total joint arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis by Yu et al 23 published in Medicine assessed the combined use of tranexamic acid and epinephrine in the total joint arthroplasty. The authors included 3 studies comparing TKA 15,20,24 and 2 studies 22,25 comparing THA.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

Zeng

et al. 2018

Orthopaedic Surgery

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The present study assessed the effectiveness of the combined administration of tranexamic acid (TXA) plus low‐dose epinephrine in primary total knee arthroplasty (TKA). We searched the following Chinese electronic databases: China National Knowledge Infrastructure and WanFang Data. We also searched the following English electronic databases: PubMed, Embase, Web of Science, and Central Register of Controlled Trials. To search for additional eligible studies, we also used Google's search engine. All randomized controlled trials (RCT) comparing TXA plus low‐dose epinephrine (Combined group) and TXA alone in TKA were systematically searched. The primary outcomes were total blood loss, hidden blood loss, the requirement for transfusion, maximum hemoglobin (Hb) drop, and deep venous thrombosis (DVT). Drainage volume, operation time, length of stay, hospital for special surgery (HSS) score, and range of motion (ROM) were considered as secondary outcomes. Subgroup analyses were performed to assess the benefits of using a tourniquet and the application routes of topical or intravenous TXA between the two groups. Statistical analysis was assessed using RevMan 5.3 software. Four independent RCT were included involving 426 patients, with 213 patients in the Combined group and 213 patients in the TXA alone group. In the Combined group there was significant reduction in total blood loss (MD, 204.70; 95% CI, −302.76 to −106.63; P < 0.0001), hidden blood loss (MD, 185.63; 95% CI, −227.56 to −143.71; P < 0.00001), drainage volume (MD, 93.49; 95% CI, −117.24 to −69.74; P < 0.00001), and maximum Hb drop (MD, 5.33, 95% CI, −6.75 to −3.91; P < 0.00001). No statistical differences were found postoperatively in terms of the requirement for transfusion (risk ratio, 0.52; 95% CI, 0.26–1.04; P = 0.06), operation time (MD, 0.85; 95% CI, −2.62 to 4.31; P = 0.63), length of stay (MD, −0.02; 95% CI, −0.52 to 0.47; P = 0.93), HSS score (MD, 0.78; 95% CI, −0.36 to 1.92; P = 0.18), and ROM (MD, 1.40; 95% CI, −1.01 to 3.81; P = 0.26), and not increasing the risk of DVT (risk ratio, 1.00; 95% CI, 0.33 to 3.02; P = 1.00) in the two groups. This meta‐analysis demonstrated that the administration of tranexamic acid plus low‐dose epinephrine is a safe and efficacious treatment to reduce total blood loss, hidden blood loss, drainage volume, and maximum Hb drop in primary TKA, without increasing the risk of DVT in primary THA.

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Tranexamic acid plus diluted-epinephrine versus tranexamic acid alone for blood loss in total joint arthroplasty

Abstract: Supplemental Digital Content is available in the text

Cited by 12 publications

References 19 publications

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

The Efficacy and Safety of Tranexamic Acid Combined with Rivaroxaban in Prevention of Clinical Events in Patients after Total Knee/ Hip Arthroplasty: A Meta-analysis

Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

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