Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial

Zekcer, Ari; Priori, Ricardo Del; Tieppo, Clauber; Silva, Ricardo Soares da; Severino, Nilson Roberto

doi:10.1590/1677-5449.007515

Cited by 11 publications

(5 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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

View full text Add to dashboard Cite

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...

show abstract

Section: Resultsmentioning

confidence: 99%

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

View full text Add to dashboard Cite

show abstract

“…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%

“…With regard to the administration route, the 111 RCTs [ 12 , 15 , 16 , 21 , 22 , 26 , 30 – 35 , 37 – 40 , 42 – 45 , 47 – 55 , 57 , 59 – 64 , 66 – 68 , 70 – 87 , 89 – 95 , 97 – 100 , 103 , 105 – 150 , 152 – 157 ] comparing IV TXA versus controls, on 5,599 and 4,980 patients, respectively, reported a rate of VTE equal to 2.7% and 2.6%, respectively (OR 0.96 [95% CI 0.77-1.20]; p = 0.709). The 45 RCTs [ 11 , 21 , 24 , 25 , 27 , 28 , 36 , 41 , 45 – 47 , 56 , 58 , 65 , 69 , 75 , 79 – 81 , 88 , 96 , 99 , 101 , 102 , 104 – 108 , 117 , 118 , 123 , 126 , 127 , 129 – 132 , 134 – 137 , 139 , 140 , 144 ] comparing IA TXA administration (2,756 patients) and controls (2,495 patients) reported a ...…”

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

View full text Add to dashboard Cite

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.

show abstract

“…Table 2 -Specification of selected articles. Positive results for thromboembolic events Zekcer et al (2016) recorded one case of DVT, which was observed in the topical group (in the gastrocnemius vein), no cases in the intravenous group, and four cases in the placebo group (one in the popliteal vein and three in the gastrocnemius vein). All these events were diagnosed by duplex ultrasound and the patients were all asymptomatic.…”

Section: Resultsmentioning

confidence: 99%

Thromboembolic event index after total knee arthroplasty with the use of tranexamic acid: an integrative review

Alves

Eustáquio

Gomes

et al. 2022

RSD

View full text Add to dashboard Cite

Total knee arthroplasty (TKA) is a surgical procedure that consists of replacing the weight-bearing surfaces of the affected joint with a prosthesis, aiming at relieving pain and correcting deformities. Due to the inherent risk of venous thromboembolism, drugs are used for its prophylaxis. This integrative literature review aimed to analyze the complications involved in the use of tranexamic acid in patients undergoing total knee arthroplasty (TKA), specifically the thromboembolic events that occurred. Studies were selected from PubMed, SciELO, Medline and Thieme electronic databases. Eleven randomized clinical trials were included. The total number of patients included in the studies was 1.299 who underwent TKA. In total, seven thromboembolic events were recorded, thus occurring in 0.5% of the cases analyzed. Thus, the safety of the use of tranexamic acid is proven, so that 99.5% of the patients did not present thromboembolic events, with the index relative to positive cases being practically irrelevant. Thus, the concluion is that the drug is safe and effective to be used in this surgical procedure, in order to minimize bleeding, rarely resulting in thromboembolic events.

show abstract

Topical vs. intravenous administration of tranexamic acid in knee arthroplasty and prevalence of deep venous thrombosis: a randomized clinical trial

Cited by 11 publications

References 36 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

Thromboembolic event index after total knee arthroplasty with the use of tranexamic acid: an integrative review

Contact Info

Product

Resources

About