Tranexamic acid reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Raviraj, A.; Anand, Ashish; Chakravarthy, Murali; Kumarswamy, S.; Prabhu, Ajith; Pai, Sanjay

doi:10.1007/s00590-011-0845-3

Cited by 14 publications

(12 citation statements)

References 40 publications

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“…Of the included studies, 12 articles were in English [9–20] and 3 were in Chinese, [21–23] and all were published in 2009 or later. The characteristics of the studies that were included are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…All the included studies were published in 2009 or later, and most of the studies were from the year 2014. Four RCTs [12,14,19,20] were of high quality and 3 RCTs [15,16,22] did not state the random sequence generation. Two studies [16,22] did not involve allocation concealment, blinding of participants and personnel and blinding of the outcomes, and 1 RCT [21] is unclear concerning these criteria.…”

Section: Discussionmentioning

confidence: 99%

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The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty

Weng¹,

Zhang²,

et al. 2016

Medicine

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Objective:A meta-analysis was performed to investigate the effectiveness and safety of tranexamic acid (TXA) for the treatment of blood loss after a bilateral total knee arthroplasty (TKA).Methods:Patients prepared for bilateral TKA and intervention including TXA versus placebo were comprehensively retrieved from MEDLINE (PubMed), Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from the time of the establishment of these databases to January 2016. The outcomes were all calculated by Stata 12.0 software. The continuous endpoints (total blood loss and blood loss in drainage) were calculated as mean difference (MD) and 95% confidence intervals (CIs). Binary variables (the need for transfusion, and the occurrence of deep venous thrombosis [DVT]) were calculated as relative risk (RR) with 95% CIs.Results:Pooled results revealed that treatment with TXA associated with less need for transfusion (P = 0.000) and the value of Hb drop postoperatively (P = 0.290) after bilateral TKA. The results also indicated that TXA can decrease the total blood loss and blood loss in drainage after bilateral TKA (P < 0.05). Meanwhile, TXA can decrease the blood units transfused per patient by 1.23 U (P = 0.001). There is no statistically significant difference in terms of the occurrence of DVT between the 2 groups (P = 0.461).Conclusion:Based on the current evidence, TXA can decrease the need for transfusion and the total blood loss without increasing the occurrence of DVT, and its administration is recommended routinely in bilateral TKA.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty

Weng¹,

Zhang²,

et al. 2016

Medicine

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“…23 The TXA group had a smaller decrease in haemoglobin level (1.29 vs. 1.46 g/dl), less blood loss in the drain (402 vs. 569 ml), and required fewer allogeneic blood transfusion units (0.07 vs. 0.3 units) than those without TXA. 12 Intravenous TXA, intra-articular TXA injection after wound closure, and an intra-articular TXA wash after cementing of implants and before closure of the retinaculum are comparably effective. 14,15,24,25 The intra-articular TXA wash can directly target the site of bleeding within a contained joint cavity; it reduces the marked increase in local fibrinolysis after release of the tourniquet, and increases microvascular haemostasis.…”

Section: Discussionmentioning

confidence: 99%

“…Neither intravenous nor intra-articular TXA result in an increased risk of thromboembolic complications. [7][8][9][10][11][12][13]23 The haemoglobin balance method takes into consideration the amount of hidden blood loss that cannot be directly measured by the drain output. 26 Intra-operative blood loss can also be estimated by: (1) subtracting the total amount of wash given from the total suction volume intra-operatively, or (2) subtracting the weight of used swabs from their original weight (1 g=1 ml).…”

Section: Discussionmentioning

confidence: 99%

“…Both intra-articular and intravenous TXA have been used to reduce blood loss and transfusion requirement for TKA. [7][8][9][10][11][12][13] Intraarticular application of TXA results in less systemic side-effects such as thrombosis, yet provides comparable effects in reducing blood loss and transfusion requirement. 14,15 This study compared the outcome after simultaneous bilateral TKA with or without intra-articular TXA wash in terms of blood loss, haemoglobin change, and transfusion requirement.…”

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confidence: 99%

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Intra-Articular Tranexamic Acid Wash during Bilateral Total Knee Arthroplasty

Zhu

Chen

Yew

et al. 2015

J Orthop Surg (Hong Kong)

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Purpose.To compare the outcome after simultaneous bilateral total knee arthroplasty (TKA) with or without an intra-articular tranexamic acid (TXA) wash in terms of blood loss, haemoglobin change, and transfusion requirement. Methods. 35 women and 10 men (mean age, 67.5 years) who underwent primary simultaneous bilateral TKA by a single senior surgeon were compared with 45 matched controls. In the TXA group, 1500 mg of TXA diluted in 100 ml of 0.9% sodium chloride was administered as a wash after cementing of implant and before closure of the retinaculum. At least 5 minutes of contact time was allowed before wound closure and tourniquet deflation. No drain was used. Results. No patients had thromboembolic complication. Compared with controls, the TXA group had lower perioperative blood loss (920 vs. 657 ml, p=0.001), total blood loss (997 vs. 679 ml, p<0.001), blood transfusion rate (60% vs. 37.8%, p=0.035), percentage of patients requiring more than Intra-articular tranexamic acid wash during bilateral total knee arthroplasty Surgery 2015;23(3):290-3 one blood unit (24.4% vs. 8.9%, p=0.048), and length of hospitalisation (6 vs. 4 days, p<0.001). Nonetheless, the 2 groups were comparable in blood units and volume transfused. Journal of OrthopaedicConclusion. An intra-articular TXA wash during simultaneous bilateral TXA reduced total blood loss and resulted in a difference of 22.2% in blood transfusion rate and a 2-day reduction in the length of hospital stay.

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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 reduces blood loss in simultaneous bilateral total knee arthroplasty: a randomized control trial

Cited by 14 publications

References 40 publications

The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty

The effectiveness and safety of tranexamic acid in bilateral total knee arthroplasty

Intra-Articular Tranexamic Acid Wash during Bilateral Total Knee Arthroplasty

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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