A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty

Tan, Jixiang; Chen, Hong; Q, Liu; Chen, Cheng; Huang, Wei

doi:10.1016/j.jss.2013.03.099

Cited by 133 publications

(111 citation statements)

References 37 publications

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“…5 In orthopaedic surgery, TXA has proved effective in total knee and hip replacement procedures in placebo-controlled trials. [6][7][8] The efficacy of TXA has also been assessed in spine surgery. 10 Initial data supporting its effectiveness were from retrospective case series or heterogeneous cohort studies.…”

mentioning

confidence: 99%

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Colomina

Koo

Basora

et al. 2017

British Journal of Anaesthesia

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Abstract15 Background. Perioperative tranexamic AQ5 acid (TXA) use can reduce bleeding and transfusion requirements in several types of surgery, but level I evidence proving its effectiveness in major spine surgery is lacking. This study was designed to investigate the hypothesis that TXA reduces perioperative blood loss and transfusion requirements in patients undergoing major spine procedures. Methods. We conducted a multicentre, prospective, randomized double-blind clinical trial, comparing TXA with placebo in 20 posterior instrumented spine surgery. Efficacy was determined based on the total number of blood units transfused and the perioperative blood loss. Other variables such as the characteristics of surgery, length of hospital stay, and complications were also analysed. Results. Ninety-five patients undergoing posterior instrumented spine surgery (fusion of >3 segments) were enrolled and randomized: 44 received TXA (TXA group) and 51 received placebo (controls). The groups were comparable for duration of 25 surgery, number of levels fused, and length of hospitalization. Transfusion was not required in 48% of subjects receiving TXA compared with 33% of controls (P ¼ 0.05). Mean number of blood units transfused was 0.85 in the TXA group and 1.42 with placebo (P ¼ 0.06). TXA resulted in a significant decrease in intraoperative bleeding (P ¼ 0.01) and total bleeding (P ¼ 0.01) relative to placebo. The incidence of adverse events was similar in the two groups. Conclusions. TXA did not significantly reduce transfusion requirements, but significantly reduced perioperative blood loss 30 in adults undergoing major spinal surgery.Clinical trial registration. NCT01136590.

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mentioning

confidence: 99%

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Colomina

Koo

Basora

et al. 2017

British Journal of Anaesthesia

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“…Like this study, most trials favor IV-TXA and have not noted an increased onset of clinically significant thrombosis. A recent meta-analysis reviewed 19 randomized controlled trials (RCTs) and concluded that a multiple-dose regimen and total dose ≥ 30 mg/kg IV-TXA significantly reduced postoperative blood loss by a mean of 290 mL and total blood loss by a mean of 570 mL in comparison to a saline control (35). Most RCTs have found no significant reduction in intraoperative blood loss between TXA and control groups (35).…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis reviewed 19 randomized controlled trials (RCTs) and concluded that a multiple-dose regimen and total dose ≥ 30 mg/kg IV-TXA significantly reduced postoperative blood loss by a mean of 290 mL and total blood loss by a mean of 570 mL in comparison to a saline control (35). Most RCTs have found no significant reduction in intraoperative blood loss between TXA and control groups (35). Tanaka et al (19) posited that TXA would have its greatest hemostatic effect once before surgery and once before release of the tourniquet because suppression of fibrinolysis at the start of surgery may be more effective than suppression only when hyperfibrinolysis peaks.…”

Section: Discussionmentioning

confidence: 99%

Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

Yang²,

Shi

et al. 2014

BST

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“…[10][11][12] Pro-thrombotic agents such as tranexamic acid can be given intravenously or topically. [13][14][15][16] It also includes the use of local anaesthetic agents mixed with adrenaline that are given at various stages of the operation. 17,18 Improved pain scores when a tourniquet has not been used have been documented.…”

Section: Introductionmentioning

confidence: 99%

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

et al. 2018

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INTRODUCTIONTotal knee replacement (TKR) is an extremely common operation with nearly 70,000 performed each year in the UK. 1 With an increasingly ageing population, demands for this surgical intervention are likely to rise. TKR has traditionally been carried out with the use of a tourniquet placed in a proximal thigh position and set to a pressure of 300 mmhg for either the entirety or part of the operation. The benefits of using a tourniquet are often quoted as a reduction in blood loss during the operation and a reduction in the operative time by allowing the surgeon a bloodless operative field.2,3 It is also thought to improve the cementing technique during prosthetic implantation as the bloodless field permits better penetration of cement into bone.4,5 However these presumptions have been questioned. ABSTRACTBackground: Primary total knee replacement (TKR) has traditionally been carried out with the use of a tourniquet. More recent trends towards performing the surgery without a tourniquet have had some support in the literature and may improve patient recovery. Methods: A retrospective cohort of 198 consecutive primary TKRs from our institution were identified and analysed, 52 used a tourniquet and 146 did not. All TKRs also utilised a standardised interventions protocol including withholding of anticoagulants and antiplatelet medications, topical adrenaline injection, and both IV and topical tranexamic acid. Outcomes measured were estimated intra-operative blood loss, overall blood loss through comparison of pre and post-operative haemoglobin laboratory values, and the need for post-operative blood transfusion. Results: Analysis demonstrated a statistically significant reduction in estimated intra-operative blood loss when a tourniquet was used (p<0.001). However, overall blood loss indicated by the haemoglobin drop after surgery was not significantly affected by tourniquet use (p=0.342). Transfusion requirements were also similar among the groups (4.8% vs. 5.8%) and no tendency was suggested towards an increased rate of transfusion in the non-tourniquet group. Conclusions: Our study shows that although estimated intra-operative blood loss is increased without a tourniquet, total blood loss as measured by haemoglobin levels is no different for primary TKRs that use a tourniquet and those that do not. Furthermore there is no difference in post-operative blood transfusion rates. It is our hope that this study will add to the body of evidence for surgeons to consider no longer using a tourniquet for primary TKR.

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A meta-analysis of the effectiveness and safety of using tranexamic acid in primary unilateral total knee arthroplasty

Cited by 133 publications

References 37 publications

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Intraoperative tranexamic acid use in major spine surgery in adults: a multicentre, randomized, placebo-controlled trial

Repeated doses of intravenous tranexamic acid are effective and safe at reducing perioperative blood loss in total knee arthroplasty

A comparison of blood loss and the need for transfusion following primary total knee replacement with or without the use of a tourniquet

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