Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: A meta-analysis of randomized controlled trials

Jie, Shang; Wang, Haibo; Zheng, Bai jun; Min, Rui; Wang, Yehua

doi:10.1016/j.ijsu.2016.11.033

Cited by 31 publications

(24 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Considering the safety impact of pharmacist interventions, we found no significant increase in adverse events, which was in accord with the findings of other studies . During the intervention phase, adverse events included surgical site infections, haematoma and DVT.…”

Section: Discussionsupporting

confidence: 91%

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Zhou

Bao

2019

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Background: Total knee arthroplasty (TKA) is associated with blood loss and an increased risk of transfusion. Guidelines for antifibrinolytic drug tranexamic acid (TXA) treatment in TKA patients are available. We evaluated the effects of anticoagulant pharmacist intervention on perioperative blood conservation treatment in TKA patients. Methods: In a retrospective, observational experimental study, patients admitted for TKA were allocated into the control or pharmacist intervention group. In the intervention phase, multiple interventions of TXA treatment based on guidelines were implemented. The primary endpoint was blood loss. Other outcome included postoperative haemoglobin and haematocrit levels, allogeneic blood transfusion, cost savings and safety. Results: A total of 177 patients were included (88 and 89 in the control and intervention group, respectively). In the intervention group, 24.72% orders of TXA dosage, 20.22% orders of drug choice, 26.97% orders of TXA timing and 30.34% orders of TXA administration manner were adjusted. Eighty-nine (100%) patients received blood conservation therapy compared with 21 (23.86%) patients in the control group (P < 0.001). Total blood loss was 1133.31 ± 627.08 mL in the control group compared with 604.34 ± 459.09 mL in the intervention group (P < 0.001). Postoperative drops in haemoglobin and haematocrit in the control group were greater than in the intervention group (P < 0.001). The rate of allogeneic blood transfusion was 40.91% in the control group compared with 21.35% in the intervention group (P = 0.01). Pharmacist intervention was conducted to cost savings resulting from reduced transfusion, but with comparable safety profile. Conclusions: Anticoagulant pharmacist intervention on blood conservation treatment of TKA patients leads to favourable clinical and economic outcome.allogeneic blood transfusion, blood conservation, pharmacist intervention, tranexamic acid, venous thromboembolism Abbreviations: BMI, body mass index; DVT, deep vein thrombosis; Hb, haemoglobin; Hct, haematocrit; TKA, total knee arthroplasty; TXA, tranexamic acid; VTE, venous thromboembolism.

show abstract

Section: Discussionsupporting

confidence: 91%

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Zhou

Bao

2019

Basic Clin Pharma Tox

View full text Add to dashboard Cite

show abstract

“…Many studies have shown that the application of a tourniquet decreases intraoperative blood loss in TKA, [10,11] and the topical application of tranexamic acid reduces the drainage volume after TKA. [12–14] However, dominant blood loss should not be underestimated when volumes can range from 380 to 800 mL.…”

Section: Discussionmentioning

confidence: 99%

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

Han³

et al. 2017

Medicine

View full text Add to dashboard Cite

Background:This study investigates the clinical effects of sealing the femoral canal by intramedullary alignment instrumentation in total knee arthroplasty (TKA).Methods:One hundred twenty consecutive patients with knee osteoarthritis, who underwent unilateral TKA, were enrolled in the study and equally randomized into 2 groups: the sealing group and the control group. In the sealing group, the femoral canal was sealed with autogenous bone and cement using intramedullary alignment instrumentation, while the femoral hole was left open for patients in the control group. Blood loss, hemoglobin (Hb) reduction, and other parameters were recorded, as well as the duration of hospital stay and complications. The Hospital for Special Surgery (HSS) knee score was used to assess knee function at the final follow-up appointment.Results:The calculated blood loss, hidden blood loss, transfusion requirements, drainage volume, and Hb reduction measurements were significantly different (P < .05) between the 2 groups. There were no significant differences in the surgery time, intraoperative blood loss, length of hospital stay, HSS score or complications between the 2 groups (P > .05).Conclusions:Sealing the intramedullary canal with autologous bone and a cement plug is an effective method for reducing blood loss and decreasing blood transfusion requirements during TKA procedures that have increasing complication rates.

show abstract

“…Nevertheless, two RCTs concluded that intra-articular regimen of TXA is as effective as three doses IV regimen in preventing blood loss without any difference in thromboembolic complications[93,94]. In addition to all these studies some authors have noticed that the combination of IV and intra-articular TXA is more effective than either regimen used alone[95,96]. All these conflicting results suggest that more well-conducted randomised controlled trials are needed to produce strong evidences about it.…”

Section: Intra-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

View full text Add to dashboard Cite

Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

show abstract

Combined intravenous and topical tranexamic acid versus intravenous use alone in primary total knee and hip arthroplasty: A meta-analysis of randomized controlled trials

Abstract: Based on our study, Combined use of intravenous and topical TXA is more effective than intravenous TXA alone in primary total knee or hip arthroplasty without increasing the risk of thromboembolic complications. Further high quality studies with more patients are needed in future studies.

Cited by 31 publications

References 22 publications

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Effects of sealing the intramedullary femoral canal in total knee arthroplasty

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Contact Info

Product

Resources

About