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

Wu, Yuangang; Zeng, Yi; Hu, Quanjun; Bao, Xianchao; Xiong, Huazhang; Shen, Bin

doi:10.1111/os.12404

Cited by 11 publications

(7 citation statements)

References 31 publications

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“…Hunt et al estimated a reduction of 120,000 deaths worldwide each year if TXA was given to all patients with severe traumatic bleeding ( Hunt, 2015 ). TXA was also demonstrated to be a safe and effective choice in total knee arthroplasty (TKA), total hip arthroplasty (THA), cardiac surgery, and other types of surgeries ( Wu et al, 2018 ; Zhang Y. et al, 2019 ; Sukeik et al, 2020 ). Moreover, TXA has also been reported in treating postpartum hemorrhage ( Novikova et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

et al. 2022

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Background: Tranexamic acid (TXA) has been applied in various types of surgery for hemostasis purposes. The efficacy and safety of TXA are still controversial in different surgeries. Guidelines for clinical application of TXA are needed.Materials and method: We systematically searched multiple medical databases for meta-analyses examining the efficacy and safety of TXA. Types of surgery included joint replacement surgery, other orthopedic surgeries, cardiac surgery, cerebral surgery, etc. Outcomes were blood loss, blood transfusion, adverse events, re-operation rate, operative time and length of hospital stay, hemoglobin (Hb) level, and coagulation function. Assessing the methodological quality of systematic reviews 2 (AMSTAR 2) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) were used for quality assessment of the included meta-analyses. Overlapping reviews were evaluated by calculating the corrected covered area (CCA).Result: In all, we identified 47 meta-analyses, of which 44 of them were of “high” quality. A total of 319 outcomes were evaluated, in which 58 outcomes were assessed as “high” quality. TXA demonstrates significant hemostatic effects in various surgeries, with lower rates of blood transfusion and re-operation, shorter operative time and length of stay, and higher Hb levels. Besides, TXA does not increase the risk of death and vascular adverse events, but it is a risk factor for seizure (a neurological event) in cardiac surgery.Conclusion: Our study demonstrates that TXA has a general hemostatic effect with very few adverse events, which indicates TXA is the recommended medication to prevent excessive bleeding and reduce the blood transfusion rate. We also recommend different dosages of TXA for different types of adult surgery. However, we could not recommend a unified dosage for different surgeries due to the heterogeneity of the experimental design.Systematic Review Registration:clinicaltrials.gov/, identifier CRD42021240303

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Section: Introductionmentioning

confidence: 99%

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

et al. 2022

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“…Zubairi et al[ 21 ] also demonstrated that epinephrine was effective in reducing the amount of blood loss and transfusion needs in the surgical treatment of knee contracture. Wu et al[ 22 ] reported that epinephrine together with tranexamic acid decreased blood loss in total hip arthroplasty. In the literature, the use of epinephrine in the field of orthopedic surgery involves the studies conducted in the adult patients.…”

Section: Discussionmentioning

confidence: 99%

Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip?

Türközü

2023

Jt Dis Relat Surg

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Objectives In this study, we aimed to investigate whether the use of epinephrine solution-impregnated gauzes and irrigation fluid with epinephrine could reduce perioperative blood loss during the combined surgical treatment of developmental dysplasia of the hip (DDH) patients. Patients and methods Between January 2018 and June 2023, a total of 68 pediatric patients (8 males, 60 females; mean age: 32.4±13.2 months; range, 18 to 98 months) who underwent combined surgery for DDH were retrospectively analyzed. The patients were divided into two groups as those who used topical epinephrine in the surgical sites during combined surgical treatment (n=34) and those who did not (n=34). Demographic and clinical characteristics and pre-, intra-, and postoperative data were recorded. To avoid transfusion complications, blood transfusion was performed in only symptomatic patients in the postoperative period. Results Age, sex, weight, and surgical duration were similar between the two groups (p>0.05). No statistically significant difference was found between the groups in terms of preoperative hemoglobin and hematocrit levels (p>0.05) There were statistically significantly differences between the groups in terms of postoperative hemoglobin and hematocrit levels, perioperative amount of blood loss, and postoperative length of hospital stay (p<0.001). No significant difference was found between the groups in terms of intraoperative hemodynamic parameters (p>0.05). The differences in perioperative and estimated intraoperative blood loss amounts and length of hospital stay were statistically significant between the groups (p<0.001). There was a significant relationship between the groups in terms of perioperative and estimated intraoperative blood loss, and transfusion of blood products (p<0.01). Blood transfusion was administered to five patients in the no epinephrine group. No local complications were observed in any group; however, one patient had transfusion-related fever and one patient had allergic skin lesions in the no epinephrine group. Conclusion The intraoperative topical use of epinephrine irrigation solution and epinephrine solution-impregnated gauze dressings is effective and safe in reducing blood loss in DDH patients.

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“…Huang et al [ 17 ] from our institution has proved that TKA patients treated with multiple doses of intravenous and topical TXA had less hidden blood loss, better knee function recovery, and better early satisfaction than controlled patients. Multiple doses of intravenous TXA application can prevent systemic plasminogen activation and delay fibrinolysis, which can result in intraoperative blood loss and postoperative hidden blood loss reduction [ 18 ]. Compared with intravenous TXA, topical application can provide a maximum concentration of TXA at the bleeding site, lower TXA absorption, reduce limb swelling, and improve wound-healing [ 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial

Zeng

et al. 2021

BMC Musculoskelet Disord

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Background The role of a tourniquet is still controversial for patients undergoing total knee arthroplasty (TKA). Our current study was performed to determine whether the nonuse of the tourniquet combine with tranexamic acid (TXA) application in TKA patients with end-stage osteoarthritis would accelerate the perioperative recovery rate and provide enough cement mantle thickness for implant fixation. Methods In this prospective, randomized controlled trial, 150 end-stage knee osteoarthritis patients receiving TKA were divided into three groups: group A (tourniquet group), group B (non-tourniquet group), and group C (tourniquet in cementation group). All enrolled patients received 3 g of intravenous TXA and 1 g topical TXA. The primary outcomes included blood loss variables and transfusion values. The secondary outcomes included VAS pain score, inflammatory factors level, range of motion, HSS score, postoperative hospital stay, and complication. Furthermore, by using a digital linear tomosynthesis technique, tibial baseplate bone cement mantle thickness was measured in four zones based on the knee society scoring system. Results No significant difference was found among the three groups with regards to total blood loss, transfusion, and complication. However, patients in group B showed lower inflammatory factors levels, shorter length of hospital stay, better range of motion, and lower postoperative pain. No significant difference was found among the three groups in four zones in terms of bone cement mantle thickness. Conclusions For end-stage knee osteoarthritis patients, the absence of tourniquet did not appear to affect blood loss and cement penetration in TKA patients. Furthermore, less inflammation reaction and better knee function can be achieved without a tourniquet. We recommend no longer use a tourniquet in primary TKA for patients with end-stage osteoarthritis when TXA is administrated. Trial registration ChiCTR-INR-16009026. Level of evidence Therapeutic Level I.

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

Cited by 11 publications

References 31 publications

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

Does Tranexamic Acid Reduce the Blood Loss in Various Surgeries? An Umbrella Review of State-of-the-Art Meta-Analysis

Does epinephrine use reduce perioperative blood loss during pelvic and femoral osteotomy with open reduction of the patients with developmental dysplasia of the hip?

Effects of tourniquet use on clinical outcomes and cement penetration in TKA when tranexamic acid administrated: a randomized controlled trial

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