Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial

Spitler, Clay A.; Row, Elliot; Gardner, Warren E.; Swafford, Rachel; Hankins, Michael J.; Nowotarski, Peter J.; Kiner, Dirk

doi:10.1097/bot.0000000000001480

Cited by 33 publications

(53 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As with the data presented previously, several routes of administration were utilized with some studies included combination therapies (e.g., IV and topical TXA) [64,65]. Interestingly, while these metaanalyses found TXA to be effective in lowering transfusion rates and blood loss in lower energy trauma, a recent prospective trial by Spitler et al found minimal effect of TXA in higher energy trauma including pelvic, acetabular, and femur fractures in younger patients [66].…”

Section: Tranexamic Acidmentioning

confidence: 96%

Hemostatic Adjuncts in Orthopedic Surgery: Innovations in Technique, Technology, and Biosurgical Applications

Konopitski¹,

Nwachuku²

2020

Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties - Volume 2 [Working Title]

View full text Add to dashboard Cite

Significant blood loss is an obstacle frequently encountered in orthopedic surgery in both elective and trauma settings. Notwithstanding the nature of orthopedic surgery creates a unique environment, where hemostasis may be difficult to achieve. In total hip and knee arthroplasty, freshly cut bone edges bleed persistently and often do not respond to typical hemostatic methods utilized in soft tissues. Spine surgery requires strict adherence to hemostatic principles as uncontrolled bleeding can result in compression of neural elements. Blood loss in orthopedic trauma presents a highly variable environment where methods of hemostasis must match the severity of the injury. Lastly, orthopedic tumor procedures often require bloodless fields in order to limit the risk of hemostatic spread. The following chapter takes a subspecialized approach to blood loss management in orthopedic surgery, including perioperative management of anticoagulant medications, protocols for utilization of pharmacologic agents, and techniques for the application of topical hemostatic compounds.

show abstract

Section: Tranexamic Acidmentioning

confidence: 96%

Hemostatic Adjuncts in Orthopedic Surgery: Innovations in Technique, Technology, and Biosurgical Applications

Konopitski¹,

Nwachuku²

2020

Contemporary Applications of Biologic Hemostatic Agents Across Surgical Specialties - Volume 2 [Working Title]

View full text Add to dashboard Cite

show abstract

“…Two RCTs exploring the effects of intravenous TXA in PAF patients found that TXA offered no significant reduction in transfusion incidence, though one noted a reduction of total blood loss [70,71]. Both also concluded no significant increase in VTE with TXA use [70,71].…”

Section: Txa Usementioning

confidence: 99%

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

Yakkanti

Mohile

Cohen-Levy

et al. 2021

Arch Orthop Trauma Surg

View full text Add to dashboard Cite

Purpose The American Academy of Orthopaedic Surgeons does not currently provide clinical practice guidelines for management of PAF. Accordingly, this article aims to review and consolidate the relevant historical and recent literature in important topics pertaining to perioperative management of PAF. Methods A thorough literature review using PubMed, Cochrane and Embase databases was performed to assess preoperative, intraoperative and postoperative management of PAF fracture. Topics reviewed included: time from injury to definitive fixation, the role of inferior vena cava filters (IVCF), tranexamic acid (TXA) use, intraopoperative cell salvage, incisional negative pressure wound therapy (NPWT), intraoperative antibiotic powder use, heterotopic ossification prophylaxis, and pre-and postoperative venous thromboembolism (VTE) prophylaxis. Results A total of 126 articles pertaining to the preoperative, intraoperative and postoperative management of PAF were reviewed. Articles reviewed by topic include 13 articles pertaining to time to fixation, 23 on IVCF use, 14 on VTE prophylaxis, 20 on TXA use, 10 on cell salvage, 10 on iNPWT 14 on intraoperative antibiotic powder and 20 on HO prophylaxis. An additional eight articles were reviewed to describe background information. Five articles provided information for two or more treatment modalities and were therefore included in multiple categories when tabulating the number of articles reviewed per topic. ConclusionThe literature supports the use of radiation therapy for HO prophylaxis, early (< 5 days from injury) surgical intervention and the routine use of intraoperative TXA. The literature does not support the routine use of iNPWT or IVCF. There is inadequate information to make a recommendation regarding the use of cell salvage and wound infiltration with antibiotic powder. While the routine use of chemical VTE prophylaxis is recommended, there is insufficient evidence to recommend the optimal agent and duration of therapy.

show abstract

“…It is an effective agent against plasmin, tissue plasminogen activators, and plasminogen [9]. Several studies have reported that TXA can effectively reduce the rate of perioperative blood transfusion, blood loss, and drainage volume without increasing the risk of deep vein thrombosis (DVT) formation in trauma orthopedics [10][11][12][13][14]. In addition, it has been shown to be cost-effective.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems. Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P<0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P<0.05), 2.8 vs 3.3 (POD4, P<0.05), and 2.1 vs. 2.6 (PO6W, P<0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups. Conclusion To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-1800017754, retrospectively registered from 2018 to 01-01).

show abstract

Tranexamic Acid Use in Open Reduction and Internal Fixation of Fractures of the Pelvis, Acetabulum, and Proximal Femur: A Randomized Controlled Trial

Cited by 33 publications

References 33 publications

Hemostatic Adjuncts in Orthopedic Surgery: Innovations in Technique, Technology, and Biosurgical Applications

Hemostatic Adjuncts in Orthopedic Surgery: Innovations in Technique, Technology, and Biosurgical Applications

Perioperative management of acetabular and pelvic fractures: evidence-based recommendations

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Contact Info

Product

Resources

About