Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study

Nakura, Nariaki; Hirakawa, Kazuhiko; Takayanagi, Shunsaku; Saito, Akira; Tsuji, Koji; Tamaki, Yasuhiro; Ochiai, Shunsuke; Mihara, Masahiko

doi:10.1111/trf.13968

Cited by 4 publications

(3 citation statements)

References 26 publications

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“…[30] In addition to the IV TXA, the combined IA TXA was suggested effective in reducing blood loss in total hip arthroplasty. [31] Moreover, in line with our study, the IV plus IA TXA treatment was revealed to have a 37% reduced blood loss compared with IV TXA-alone at 24 and 48 hours after TKA, where no thromboembolic complications occurred. [32] Additionally, the inhibitory effect of TXA on the fibrinolytic activity was previously demonstrated in several studies.…”

Section: Discussionsupporting

confidence: 82%

Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis

Zhang¹,

Yang²,

Sun³

et al. 2019

Medicine

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Background: Total knee arthroplasty (TKA) is a surgical procedure to replace the weight-bearing surfaces of the knee joint to relieve pain and disability. However, blood loss and fibrinolytic activity, accounting for a poor prognosis following TKA operation, were relieved by fibrinolytic inhibitor tranexamic acid (TXA). For a better application of TXA function, we explored the effect of intravenous injection (IV) of TXA combined with intra-articular injection (IA) of TXA in patients after TKA. Methods: Patients admitted from Weifang People's Hospital from January 2015 to December 2016 who received TKA were injected with 20 mg/kg TXA by IV before TKA (n = 50), 3.0 g TXA by IA after TKA (n = 50), or combination of 20 mg/kg TXA by IV before TKA and 3.0 g TXA by IA after TKA (n = 50). Knee function was assessed using HSS, KSS, NASS, and ROM. In addition, the total blood loss (TBL), hidden blood loss (HBL), maximum hemoglobin (Hb) drop, fibrinolytic activity, as well as incidence of thromboembolism were measured. The patients were followed up for 6 months. The deadline for follow-up was June 2017 and the incidence of thromboembolism events within 6 months after operation was counted. Results: HSS, KSS, NASS scores, and ROM were elevated after patients receiving TKA. Patients received IV plus IA TXA has decreased TBL, HBL, and maximum Hb drop than those received IV TXA-alone and IA TXA-alone, with reductions in FDP and D-dimer, indicating that IV plus IA TXA injection is superior to prevent blood loss and hyperfibrinolysis during TKA. Age, sex, type of femoral prosthesis, and the injection method of TXA were risk factors for HBL of patients after receiving TKA. Conclusions: The aforementioned results demonstrate that TKA is an effective surgery, and IV plus IA TXA injection functions more effectively in reducing blood loss and fibrinolytic activity in patients, which is a clinical factor of occult hemorrhage.

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Section: Discussionsupporting

confidence: 82%

Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis

Zhang¹,

Yang²,

Sun³

et al. 2019

Medicine

View full text Add to dashboard Cite

show abstract

“…The efficacy of TXA in reducing blood loss and transfusion requirement has been confirmed in numerous studies but there has been debate regarding the best route of administration . Several studies have compared the efficacy of topical and intravenous administration of TXA, and others have compared the efficacy of combined administration versus intravenous or topical TXA in primary THA . While routes of TXA administration have been compared for total knee arthroplasty by our own group, few studies have directly compared the three routes in THA.…”

Section: Discussionmentioning

confidence: 99%

“…15,27 Several studies have compared the efficacy of topical and intravenous administration of TXA, 28,29 and others have compared the efficacy of combined administration versus intravenous or topical TXA in primary THA. 19,30 While routes of TXA administration have been compared for total knee arthroplasty by our own group, 31 few studies have directly compared the three routes in THA. In addition, concerns still exist about the safety of TXA in primary unilateral THA.…”

Section: Discussionmentioning

confidence: 99%

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Xie¹,

Zhang

Chen³

et al. 2019

Brit J Clinical Pharma

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Aim This study aimed to compare the efficacy and safety of different tranexamic acid (TXA) routes following primary total hip arthroplasty (THA). Methods We collected data from the National Health Database on patients registered from January 2013 to September 2017. The patients were divided based on TXA administration route into a control group (without TXA), intravenous group, topical group and combined group. The primary outcome was transfusion; secondary outcomes were total blood loss, haemoglobin level, decrease in haemoglobin on postoperative day 3, and incidence of complications. Results Data were collected on 7667 primary THA, 4662 with TXA and 3005 without TXA. The transfusion rate was 28.7% in the control group, 12.7% in the topical group, 8.9% in the intravenous group, and 6.1% in the combined group, and the inter‐group differences were significant (P < .01). The combined group showed significantly smaller total blood loss (1.23 ± 0.52 L), smaller reduction in haemoglobin level (26.5 ± 11.1 g/L) and higher haemoglobin level on postoperative day 3 (107.0 ± 15.5 g/L) than the other three groups (P < .05). The three TXA groups showed significantly lower incidence of deep vein thrombosis than the control group (0.08% vs 0.47%, P = .001) as well as a lower rate of other complications (0.34% vs 0.67%, P = .044). Conclusion TXA is effective and safe to decrease blood loss and transfusion following primary THA, regardless of whether it is administered intravenously, topically or both. Intravenous or combined routes may produce better haemostatic effects, so they may be suggested in the absence of contraindications.

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The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

Zhang¹,

Wang²,

Yang

et al. 2021

The Spine Journal

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Additional intraarticular tranexamic acid further reduced postoperative blood loss compared to intravenous and topical bathed tranexamic acid in total hip arthroplasty: a retrospective sequential series study

Abstract: This study suggests that the combined administration of topical intraarticular, bathed, and IV TXA was effective in reducing blood loss in THA patients.

Cited by 4 publications

References 26 publications

Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis

Combined intravenous and intra-articular tranexamic acid administration in total knee arthroplasty for preventing blood loss and hyperfibrinolysis

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

The effect of multiple-dose oral versus intravenous tranexamic acid in reducing postoperative blood loss and transfusion rate after adolescent scoliosis surgery: a randomized controlled trial

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