The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Wang, Fei; Zhao, Kunchi; Zhao, Mingming; Zhao, Dongxu

doi:10.1097/md.0000000000012270

Cited by 17 publications

(11 citation statements)

References 27 publications

(38 reference statements)

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“…This antifibrinolytic agent inhibits the activation of plasminogen to plasmin, preventing fibrin degradation and promoting clot stabilization. 6 In TKA, the use of TXA is effective and safe in decreasing blood loss and transfusion rate. 7 The perioperative blood loss and consequent need of transfusion increases the risk of surgical site infection, providing poorer outcomes.…”

Section: Introductionmentioning

confidence: 99%

Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

Viegas

Kumar

Carvalho³

et al. 2020

Int J Res Orthop

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Background: Tranexamic acid (TXA) is effective and safe in decreasing blood loss and transfusion rate in total knee arthroplasty (TKA). Few studies focused on the role of patients’ characteristics on the efficacy of TXA in TKA. The purpose of this study was to conduct a retrospective analysis to investigate if age, gender and BMI influence the efficacy of TXA in reducing perioperative blood loss in TKA.Methods: We did an observational study including 366 consecutive patients undergoing TKA in Hospital Particular do Algarve between January 2011 and April 2019 which were divided in two groups: intraoperative administration of intravenous TXA (TXA Group) and no administration of TXA (Control Group). The perioperative blood loss between groups and their relation with age, gender and BMI was compared.Results: Of the 366 patients, 225 (61%) received TXA. In both groups, age did not correlate to the blood loss. Women in the TXA group had less perioperative blood loss than in the control group. No such difference was found for men. The normal weight group showed no difference in perioperative blood loss with or without TXA administration. However, there was a statistically significant difference in the overweight and obese groups. The mean perioperative blood loss was higher in the control group (854±342 ml) than in the TXA group (720±335 ml).Conclusions: TXA administration is efficient in controlling TKA associated hemorrhage in overweight and obese individuals and in women but it doesn’t have that effect in normal weight patients or in men.

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Section: Introductionmentioning

confidence: 99%

Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

Viegas

Kumar

Carvalho³

et al. 2020

Int J Res Orthop

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“…In a systematic review, Muchedzi TA et al ( 20 ) included ten studies to assess average blood loss for patients during TKA, and they also did not find statistical differences between the PRP group and the control group ( P = .07). Tranexamic acid (TA) administration during TKA had been demonstrated to reduce blood loss ( 36 ). Tandogan RN et al ( 18 ) evaluated the effect of platelet-rich fibrin (PRF) on blood loss by comparing the combined utilization of PRF and TA with TA alone, and the data showed no significant difference between two groups ( P = .722).…”

Section: Discussionmentioning

confidence: 99%

The Application of Platelet-Rich Plasma for Patients Following Total Joint Replacement: A Meta-Analysis of Randomized Controlled Trials and Systematic Review

et al. 2022

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BackgroundThe clinical efficacy of platelet-rich plasma (PRP) in the treatment of total joint replacement (TJR) remains inconclusive. In this paper, systematic review and meta-analysis was adopted to assess the efficacy of using PRP for the treatment of TJR.MethodsA comprehensive search of Medline, Embase, and Cochrane library databases for randomized controlled trial (RCT) articles recording data of PRP for TJR was conducted from inception to February 2022. Outcomes concerned were pain, range of motion (ROM), WOMAC score, length of hospital stay (LOS), hemoglobin (Hb) drop, total blood loss, wound healing rate, and wound infection. The methodological quality of the included RCTs was evaluated by using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was utilized to assess the level of evidence for the outcomes. Subgroup analysis was conducted according to the type of TJR.ResultsTen RCTs were included in the meta-analysis. In the TKA subgroup, the available data demonstrated that there were significant differences in the outcomes of pain and Hb drop, while it was the opposite of ROM, WOMAC score, LOS, total blood loss, wound healing rate, and wound infection. In the THA subgroup, no significant differences could be seen between two groups in the outcomes of LOS and wound infection. However, the PRP group gained a higher wound healing rate in the THA subgroup.ConclusionThe application of PRP did not reduce blood loss but improved the wound healing rate. However, more prospective and multicenter studies are warranted to confirm these results.

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“…In another study by Zufferey et al [12] , the infection rate was 25% in the study group and 38% in the control group. In a study by Wang et al [16] , out of 124 patients, they were categorized into 3 groups. These three groups were divided in 1:1:1 ratio.…”

Section: Discussionmentioning

confidence: 99%

Estimation of efficacy on tranexamic acid in reducing peri-operative blood loss in patient undergoing hemiarthroplasty

P¹,

Prabhakaran²,

Sundaram³

et al. 2019

Int. J. Orthop. Sci.

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Introduction: Hip fracture surgeries are associated with substantial blood loss, exposing patients to postoperative anemia. The severity of anemia is related to reduced functional recovery, which is related to long-term mortality. Patients undergoing hemiarthroplasty surgeries require 1 to 2 pints of blood transfusion post operatively. There are many transfusion related health hazards. Tranexamic acid is a less expensive pharmacological agent that interferes with fibrinolysis and reduces blood loss in hemiarthroplasty surgeries. The aim of this study is to evaluate the efficacy of intra-venous administration of tranexamic acid in patients who underwent hemiarthroplasty with regards to blood loss at peri and post-operative period. Materials and Methods: Patients with fracture neck of femur, above 60 years who primarily presented to Emergency medical service medicine in our institution fulfilling the inclusion criteria were included in our study. After obtaining the informed consent, patients were grouped into two categories; group 1 and group 2. Group 1 intervention: Placebo-50 ml of normal saline intravenously was administered 10 minutes before starting the surgery. Group 2 intervention: Study-Tranexamic acid -1500mg diluted in 50ml normal saline intravenously was administered 10 minutes before the surgery. Intra-operative blood loss was assessed by collecting the number of fully soaked mopping pads, gauze pieces and the quantity of irrigation fluid after substracting the amount of saline wash. Post operatively the efficacy was assessed by evaluating the hemoglobin and packed cell volume values. The blood collected in the drain on day 1 and 2 were also analysed and compared between the control group and the study group. Result: In our study we included 40 patients who had undergone hemiarthroplasty for neck of femur fracture. Intra operatively we did PRBC transfusion for 11 patients in the control group and 3 patients in the study group. Postoperatively 2 patients received PRBC transfusion in the control group and none of the patients received PRBC transfusion in the study group. The post surgery blood loss was also very minimal in the control group as compared to the study group. Conclusion:In our study, there was a significant amount of blood loss reduction in tranexamic acid administered group when compared to the placebo group. Tranexamic acid was cost effective and safer when compared to blood components. Tranexamic acid was useful and effective in reducing intraoperative blood loss and reduces the need for blood transfusion post-operatively. Tranexamic acid should be considered for routine use in hemiarthroplasty surgery to decrease blood loss.

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The efficacy of oral versus intravenous tranexamic acid in reducing blood loss after primary total knee and hip arthroplasty

Cited by 17 publications

References 27 publications

Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

Impact of age, gender and body mass index on the efficacy of tranexamic acid in total knee arthroplasty

The Application of Platelet-Rich Plasma for Patients Following Total Joint Replacement: A Meta-Analysis of Randomized Controlled Trials and Systematic Review

Estimation of efficacy on tranexamic acid in reducing peri-operative blood loss in patient undergoing hemiarthroplasty

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