Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss

Volquind, Daniel; Zardo, Remi Antônio; Winkler, Bruno Costamilan; Londero, Bruno Bertagnolli; Zanelatto, Natália; Leichtweis, Gisele Perondi

doi:10.1016/j.bjane.2014.11.004

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…Longer surgical time also contributed to the results of more perioperative blood loss in the group tourniquet releasing before wound closure. Perioperative blood loss in TKA patients has been reported in association with drain clamping technique, [37] application of compression dressing, [38] intravenous antifibrinolytic therapy, [39] tourniquet application time, [33] and early rehabilitation programs. [10] Besides that, an early use of continuous passive motion machines could increase blood loss.…”

Section: Discussionmentioning

confidence: 99%

Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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Background:For total knee arthroplasty (TKA), the tourniquet is routinely employed for better visualization, less blood loss, and easier cementation. However, the time to release tourniquet remains controversial. Therefore, we performed current meta-analysis to assess whether releasing tourniquet before wound closure is more effective in reducing blood loss than releasing tourniquet after wound closure in TKA without an increased risk of complications.Methods:To conduct this meta-analysis, we searched Medline, Embase, Web of science, and the Cochrane library up to November 2016, for randomized controlled trials comparing tourniquet releasing before and after wound closure in TKA. A meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. Methodological quality of the trials was assessed using the Cochrane risk assessment scale. The data of the included studies were analyzed using Stata 12.0.Results:Sixteen trials involving 1010 patients were identified in current meta-analysis. Our meta-analysis demonstrated that there were no significant differences in the 2 groups in terms of calculated blood loss (weighted mean difference [WMD] = 160.65, 95% confidence interval [CI]: −0.2 to 321.49, P = .05), postoperative blood loss (WMD = −45.41, 95% CI: −120.11 to 29.29, P = .233),postoperative hemoglobin decline (WMD = 0.16, 95% CI: −2.5 to 2.82, P = .905), transfusion volume (WMD = 79.19, 95% CI: −5.05 to 163.44, P = .065),transfusion rates (relative risk [RR] = 1.19, 95% CI: 0.95–1.50, P = .134), major complications (RR = 0.51, 95% CI: 0.15–1.73, P = .278), and deep vein thrombosis (RR = 0.44, 95% CI: 0.14–1.37, P = .157).Compared with the group of releasing tourniquet after wound closure, the group of releasing tourniquet before wound closure had a higher volume of total blood loss (WMD = 130.96, 95% CI: 58.83–203.09, P = .000) and a longer operation time (WMD = 6.56, 95% CI: 3.12–10.01, P = .000). However, releasing tourniquet before wound closure could reduce minor complications (RR = 0.53, 95% CI: 0.34–0.82, P = .004).Conclusions:On the basis of current meta-analysis, the method of releasing tourniquet before wound closure could increase total blood loss and operation time; nevertheless, the risk of complications decreased. Thus, if patients are in severe anemia condition, the tourniquet perhaps should be released after wound closure to decrease blood loss. In contrary, releasing tourniquet before wound closure to decrease the risk of complications would be a better choice.

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Section: Discussionmentioning

confidence: 99%

Timing of tourniquet release in total knee arthroplasty

Zhang

Liang

et al. 2017

Medicine

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“…Many studies found in the literature also support its use for the same purpose. 14,15,17,21,[23][24][25][26][27][28] As for the instrumentation used, overall PSI showed lower blood loss in the group not using TXA. Kizaki et al reported similar findings in a 2019 meta-analysis, also giving the advantage to PSI over CI in terms of blood loss but without statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…15,16 Blood transfusions have an undeniable value but they also pose some risks such as infections, immunological reactions, and even death. 6,14,15,[19][20][21][22] The trauma caused by surgery releases from the vascular endothelium tissue plasminogen activator (TPA), the enzyme responsible for converting plasminogen into plasmin, thereby activating fibrinolysis. 21 Tranexamic acid (TXA) is an antifibrinolytic synthetic drug that limits blood loss by inhibiting this conversion (►Fig.…”

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confidence: 99%

“…6,14,15,[19][20][21][22] The trauma caused by surgery releases from the vascular endothelium tissue plasminogen activator (TPA), the enzyme responsible for converting plasminogen into plasmin, thereby activating fibrinolysis. 21 Tranexamic acid (TXA) is an antifibrinolytic synthetic drug that limits blood loss by inhibiting this conversion (►Fig. 1), thus delaying the degradation of the fibrin clot (fibrinolysis), reducing blood loss, and the need for transfusions.…”

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confidence: 99%

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Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

et al. 2021

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Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.

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“…This is in conformity with what has been found by the previous researchers [2,11] . It has been sufficiently shown that tranexamic acid administration is a useful tool to decrease postoperative blood loss in major orthopedic surgeries [12,13] . However, in spite of several studies performed, the most appropriate route of tranexamic acid administration remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy & Safety Between Intravenous and Intraarticular Tranexamic Acid in Reducing Blood Loss after Total Knee Arthroplasty

Adebayo

Nuhu

Abolaji

et al. 2019

International Journal of Orthopaedics

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; (1) Intravenous group, (2) Intraarticular group and (3) Control group. RESULTS: The postoperative blood loss was significantly greater in the control group than in intravenous and intraarticular groups (p = 0.02). Also, the postoperative fall in Hb level and the need for blood transfusion were significantly higher in the control group than in intravenous and intraarticular groups (0.00). However, Intravenous and Intraarticular groups did not differ significantly in terms of the measured variables. There was no significant difference between the preoperative and postoperative platelet counts (p = 0.81), INR (p = 0.21) and serum creatinine (p = 0.39) in all the three study groups. CONCLUSION: Intravenous and intraarticular tranexamic acid were equally effective and safe for reducing blood loss after TKA.

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Use of tranexamic acid in primary total knee replacement: effects on perioperative blood loss

Abstract: Tranexamic acid reduced postoperative bleeding without promoting thromboembolic events.

Cited by 10 publications

References 24 publications

Timing of tourniquet release in total knee arthroplasty

Timing of tourniquet release in total knee arthroplasty

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

Comparison of Efficacy & Safety Between Intravenous and Intraarticular Tranexamic Acid in Reducing Blood Loss after Total Knee Arthroplasty

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