Tranexamic Acid Reduces Perioperative Blood Loss and Hemarthrosis in Total Ankle Arthroplasty

Nodzo, Scott R.; Pavlesen, Sonja; Ritter, Christopher; Boyle, K Keely

doi:10.12788/ajo.2018.0063

Cited by 15 publications

(23 citation statements)

References 24 publications

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“…In a retrospective review of 50 patients undergoing TAR, 25 patients who received intraoperative IV TXA had a significantly lower drain output (71.6 mL vs 200.2, P < .0001) and change in pre-to postoperative hemoglobin level (0.4 vs 1.5 g/dL, P ¼ .01) compared to the 25 patients who did not receive intraoperative TXA. 25 Additionally, there was a lower wound complication rate (8% vs 20%, P ¼ .114) in patients treated with TXA vs nontreated patients; however, this was not statistically significant. 25 In a randomized controlled trial comparing outcomes after TXA vs non-TXA treatment for 90 consecutive calcaneal fractures, the TXA-treated cohort had a significantly reduced incidence of wound complications (7.3% vs 23.8%, P ¼ .036) without a significant difference in thromboembolic events or adverse drug reactions between the 2 groups.…”

Section: Discussionmentioning

confidence: 86%

“…25 Additionally, there was a lower wound complication rate (8% vs 20%, P ¼ .114) in patients treated with TXA vs nontreated patients; however, this was not statistically significant. 25 In a randomized controlled trial comparing outcomes after TXA vs non-TXA treatment for 90 consecutive calcaneal fractures, the TXA-treated cohort had a significantly reduced incidence of wound complications (7.3% vs 23.8%, P ¼ .036) without a significant difference in thromboembolic events or adverse drug reactions between the 2 groups.…”

Section: Discussionmentioning

confidence: 86%

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Tranexamic Acid Use in Foot and Ankle Surgery

Johns

Walley

Seedat

et al. 2020

Foot & Ankle Orthopaedics

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Background: There is a potential role for tranexamic acid (TXA) use in foot and ankle procedures; however, the benefits of this intervention have not been fully elucidated. The purpose of this study was to explore the safety, outcomes, and medical complication profile of the use of intravenous TXA in patients undergoing foot and ankle surgery. Methods: A prospective study with retrospective review of 241 patients undergoing elective and traumatic foot and ankle procedures was performed. One gram of intravenous (IV) TXA was administered prior to incision. Patients were followed and evaluated for medical comorbidities, intraoperative blood loss, wound complication, superficial and deep infections, hematoma formation, medical complications, 30-day hospital readmission rate, and return visits to the emergency department or urgent care setting prior to first postoperative visit. Descriptive statistics were used for subgroup analysis. Mean postoperative follow-up was 4.5 months. Results: Estimated blood loss in all cases was less than 20 mL. There was 1 case of superficial cellulitis (1/241, 0.4%), 1 deep infection after Achilles tendon repair (1/241, 0.4%), 4 cases of delayed wound healing (4/241, 1.6%), 1 instance of deep vein thrombosis (1/241, 0.4%), and 2 cases of postoperative pulmonary embolism (2/241, 0.8%). There were no instances of postoperative hematoma formation. There were no additional recorded thromboembolic events. There were no adverse drug reactions. There were no 30-day hospital readmissions or return visits to the emergency department or urgent care setting before the first postoperative visit. In a subgroup analysis, there was no significant difference in wound complications or infections between nondiabetics and diabetics ( P > .05) and traumatic and nontraumatic cases ( P > .05). Conclusions: The use of IV TXA in foot and ankle surgeries was associated with low risk of wound complications, infections, hematoma formation, thromboembolic events, and overall complication rates with minimal side effect profile. Perioperative tranexamic acid use may prove to be beneficial in foot and ankle surgery patients but especially in higher-risk patients such as those with diabetes, trauma, and those that are immunocompromised. Level of Evidence: Level IV, case series.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

Tranexamic Acid Use in Foot and Ankle Surgery

Johns

Walley

Seedat

et al. 2020

Foot & Ankle Orthopaedics

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“…4,7,8,18,20,22 Despite the extensive literature investigating TXA use in total knee and total hip arthroplasty, there is a paucity of literature involving the use of TXA in TAA. In a recent study, Nodzo et al 13 retrospectively evaluated the use of TXA in total ankle arthroplasty. They found that TXA use decreased perioperative blood loss, hemarthrosis, and wound complications compared with patients who did not receive TXA.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,8,18,20,22 There has been a paucity of literature investigating TXA use in foot and ankle surgery. In a recent article, Nodzo et al 13 showed, in a retrospective study, that TXA use in total ankle arthroplasty resulted in decreased perioperative blood loss, hemarthrosis, and wound complications when compared with patients who did not receive TXA. In another study evaluating surgery about the foot and ankle, Xie et al 21 showed that TXA reduced the postoperative blood loss wound complication rate with no reported complications.…”

Section: Introductionmentioning

confidence: 99%

Effect of Tranexamic Acid on Wound Complications and Blood Loss in Total Ankle Arthroplasty

et al. 2020

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Background: Tranexamic acid (TXA) is a medication that has been shown to decrease blood loss and risk of blood transfusion in total knee and total hip arthroplasty. The purpose of this study was to evaluate the use of TXA in patients undergoing total ankle arthroplasty (TAA). We hypothesized there would be less blood loss and wound complications in patients receiving TXA. Methods: A retrospective review of 2 patient cohorts operated on by 2 surgeons was performed from 2010 to 2018. We compared a group of TAA patients that did not receive TXA vs a subsequent group that received TXA. Patients received 1g intravenous TXA before the tourniquet was inflated followed by another 1 g after release of the tourniquet. Intraoperative blood loss was recorded and preoperative hemoglobin and hematocrit levels were compared to postoperative levels. Intraoperative and postoperative complications were compared between the 2 groups. A total of 119 patients were included in the study, of whom 55 received TXA. No significant difference existed between the 2 groups in gender, age, body mass index, or Charlson comorbidity index. Results: There was no difference in estimated blood loss, postoperative hemoglobin/hematocrit values or preoperative to postoperative change in hemoglobin/hematocrit values. Additionally, there was no difference in wound complications or overall complication rate between the groups. Conclusion: TXA has been shown to be effective in total knee and total hip arthroplasty in decreasing blood loss and transfusion risk. We did not find it to be effective in reducing intraoperative blood loss, perioperative blood loss, or wound complications in TAA. Level of Evidence: Level III, comparative study.

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“…These authors concluded that TXA may be an effective, cost-efficient, hemostatic agent when used during total ankle arthroplasty and reliably can reduce perioperative blood loss, hemarthrosis, and the risk of wound complications. 26 The utility of TXA has also been studied in the context of calcaneus fractures. Specifically, a 2015 randomized controlled trial by Xie et al was undertaken to evaluate the effect of TXA in reducing postoperative blood loss in calcaneal fractures.…”

Section: Tranexamic Acid In Foot and Ankle Surgerymentioning

confidence: 99%

Tranexamic Acid in Foot and Ankle Surgery: A Topical Review and Value Analysis

Johns

Walley

Jackson

et al. 2021

Foot & Ankle Specialist

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Tranexamic acid (TXA) has become a commonly used perioperative intervention in total joint arthroplasty, shoulder and knee arthroscopy, and spinal procedures in order to minimize blood loss, hematoma formation, hemarthrosis, and wound healing complications. There is a potential role for TXA use in foot and ankle procedures, with limited studies suggesting a potential benefit in minimizing postoperative wound complications and blood loss without an increased risk of thromboembolic events. In light of the profound clinical and financial impact of TXA use in other orthopaedic subspecialties and the early successes in foot and ankle surgery, we aim to provide more information about TXA and its use in foot and ankle surgery. Therefore, the purpose of this review is to perform a comprehensive literature review on the topic of TXA use in foot and ankle procedures in order to describe the pertinent available literature on the use of TXA in orthopaedic surgery and its implications specifically in foot and ankle surgery. It is our aim to identify potential benefits and shortcomings in the available evidence on TXA use for foot and ankle surgery in hopes to (1) best inform foot and ankle surgeons where beneficial and safe and (2) inspire further research on this topic as it relates to clinical management for foot and ankle patients. Levels of Evidence: Level IV

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Tranexamic Acid Reduces Perioperative Blood Loss and Hemarthrosis in Total Ankle Arthroplasty

Cited by 15 publications

References 24 publications

Tranexamic Acid Use in Foot and Ankle Surgery

Tranexamic Acid Use in Foot and Ankle Surgery

Effect of Tranexamic Acid on Wound Complications and Blood Loss in Total Ankle Arthroplasty

Tranexamic Acid in Foot and Ankle Surgery: A Topical Review and Value Analysis

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