Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

Shinde, Abhishek; Sobti, Anshul; Maniar, Shriji; Mishra, Amit; Gite, Raju; Shetty, Vivek

doi:10.4103/0973-6247.154251

Cited by 14 publications

(4 citation statements)

References 33 publications

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“…The electronic database and manual search yielded a total of 782 studies published between 1976 and 2018. In total, 381 articles were considered for full-text review, of which 189 were excluded because of ineligible study designs (n = 55) or control groups (n = 92), ineligible end points (n = 27), missing or nontranslatable full text (n = 11), and duplicates (n = 4), leaving 192 RCTs for final analysis (Figure). Included studies were published in English, German, French, and Spanish.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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“…Overall, 9,067 patients received TXA while 6,592 were included in the control groups. With regard to the type of surgery, 82 studies [ 21 – 24 , 26 – 28 , 30 , 31 , 34 – 38 , 40 , 45 , 47 , 49 – 51 , 55 – 58 , 60 , 61 , 63 , 65 , 66 , 70 , 72 , 73 , 75 , 76 , 78 – 82 , 84 , 85 , 87 , 88 , 90 , 92 , 93 , 96 , 98 , 99 , 104 – 111 , 113 , 114 , 117 – 119 , 121 , 123 , 124 , 126 – 128 , 130 , 134 – 137 , 140 – 142 , 146 , 147 , 151 , 153 , 154 , 156 ] (5,267 cases and 3,498 controls) were focused on TKA, 41 studies [ 11 , 12 , 25 , 32 , 33 , 42 – 44 , 48 , 52 – 54 , 62 , 64 , 67 – …”

Section: Resultsmentioning

confidence: 99%

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

Reale

Andriolo

Gürsoy

et al. 2021

BioMed Research International

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Objective. Tranexamic acid (TXA) is increasingly used in orthopedic surgery to reduce blood loss; however, there are concerns about the risk of venous thromboembolic (VTE) complications. The aim of this study was to evaluate TXA safety in patients undergoing lower limb orthopedic surgical procedures. Design. A meta-analysis was performed on the PubMed, Web of Science, and Cochrane Library databases in January 2020 using the following string (Tranexamic acid) AND ((knee) OR (hip) OR (ankle) OR (lower limb)) to identify RCTs about TXA use in patients undergoing every kind of lower limb surgical orthopedic procedures, with IV, IA, or oral administration, and compared with a control arm to quantify the VTE complication rates. Results. A total of 140 articles documenting 9,067 patients receiving TXA were identified. Specifically, 82 studies focused on TKA, 41 on THA, and 17 on other surgeries, including anterior cruciate ligament reconstruction, intertrochanteric fractures, and meniscectomies. The intravenous TXA administration protocol was studied in 111 articles, the intra-articular in 45, and the oral one in 7 articles. No differences in terms of thromboembolic complications were detected between the TXA and control groups neither in the overall population (2.4% and 2.8%, respectively) nor in any subgroup based on the surgical procedure and TXA administration route. Conclusions. There is an increasing interest in TXA use, which has been recently broadened from the most common joint replacement procedures to the other types of surgeries. Overall, TXA did not increase the risk of VTE complications, regardless of the administration route, thus supporting the safety of using TXA for lower limb orthopedic surgical procedures.

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“…Multimodal blood management protocols included drain clamping for 4 h and the use of tranexamic acid both in the LIA and intravenously. 10,23 We were able to keep the number of blood transfusions down to 0.51% patients in the UTKA group and 3.94% patients in the BTKA group. Morais et al reported no transfusions using a multimodal blood loss prevention approach in their study.…”

Section: Discussionmentioning

confidence: 90%

Decreasing hospital length of stay and enhancing recovery in Total Knee Arthroplasty

Agarwala

Butani

D'Mello

et al. 2020

Journal of Clinical Orthopaedics and Trauma

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Background: Patients undergoing Total Knee Arthroplasty (TKA) typically have early postoperative pain and decreased mobility, especially so in the first 24 h. Achieving a pain free knee in the immediate postoperative period and reducing complications using multimodal pain and blood management protocols forms a keystone in early mobilization and functional recovery. Enhanced Recovery after Surgery pathways (ERASp) since their inception, have significantly improved perioperative care and functional outcomes, thereby reducing the average length of stay (ALOS), complications and overall healthcare costs. ERASp modified suitably for TKA have had encouraging results. We have retrospectively analyzed the outcomes of the ERASp for TKA at our tertiary care centre with equal emphasis on pre-hospital preparations, in-hospital care, and post-hospital discharge. Methods: All TKA patients operated by the senior author between July 2016 and January 2018 with a minimum one year follow up were included. The outcomes measured were: Visual Analogue Score (VAS) for pain at rest and on movement, milestones, transfusion requirements, postoperative complications, ALOS and functional scores at one year follow-up. Results: 775 patients (392 unilateral TKA {UTKA} and 383 bilateral {BTKA}) met our inclusion criteria. Both groups were comparable demographically. Mean VAS pain scores at rest were 3.15 ± 2.15 on the day of surgery, 2.5 ± 1.86 on the first postoperative day and 2.08 ± 1.81 on the second day, and 6.2 ± 2.38, 5.77 ± 2.34 and 4.71 ± 2.48 on movement respectively in the UTKA group. In the BTKA group, the mean VAS pain scores at rest were 4.39 ± 2.25 on the day of surgery, 3.98 ± 2.36 on the first postoperative day and 3.05 ± 2.12 on the second day and 6.21 ± 2.38, 5.77 ± 2.34 and 4.71 ± 2.48 on movement respectively. 85.49% of UTKA and 77.22% of BTKA patients walked on the day of surgery. Decrease in haemoglobin and transfusion rates were 1.25 ± 0.41 g% and 0.5%, 1.85 ± 0.62 and 3.9% in the UTKA and BTKA groups respectively. The average length of hospital stay (LOS) was 3.98 days. LOS was 3.17 and 4.78 days with 1.55% and 6.05% major complications in the UTKA and BTKA groups respectively. There was a significant improvement in Oxford Knee and WOMAC scores at 3, 6 and 12 months in both groups. Conclusions: Pain following TKA is a major deterrent in early mobilization thereby delaying functional recovery and increasing ALOS. We recommend our multimodal interdisciplinary protocol to achieve early mobilization, better pain scores and minimize complications, resulting in overall reduced LOS.

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Tranexamic acid reduces blood loss and need of blood transfusion in total knee arthroplasty: A prospective, randomized, double-blind study in Indian population

Cited by 14 publications

References 33 publications

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

Complications of Tranexamic Acid in Orthopedic Lower Limb Surgery: A Meta-Analysis of Randomized Controlled Trials

Decreasing hospital length of stay and enhancing recovery in Total Knee Arthroplasty

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