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

Li, Junfeng; Li, Hang; Zhao, Hui; Wang, Jun; Liu, Shen; Song, Yang; Wu, Hong-Fen

doi:10.1186/s13018-017-0520-4

Cited by 63 publications

(36 citation statements)

References 24 publications

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“…The rate of infection is increasing, meaning infections are becoming difficult to treat due to increasing resistance of bacteria to antibiotics. With the passage of time, new antibiotic resistance mechanisms are emerging [6]. In addition, it has been seen in prosthetic joint infection therapy that infections due to Gram-negative bacteria are more unfavorable than those caused by the choice of a therapeutic metal ion in the chitosan complex must be optimized to achieve the desired biocompatibility of the final coating.…”

Section: Introductionmentioning

confidence: 99%

Electrophoretic Deposition and Characterization of Functional Coatings Based on an Antibacterial Gallium (III)-Chitosan Complex

et al. 2020

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Despite their broad biomedical applications in orthopedics and dentistry, metallic implants are still associated with failures due to their lack of surface biofunctionality, leading to prosthesis-related microbial infections. In order to address this issue, the current study focuses on the fabrication and characterization of a novel type of antibacterial coating based on gallium (III)-chitosan (Ga (III)-CS) complex layers deposited on metallic substrates via electrophoretic deposition (EPD). Aiming for the production of homogeneous and monophasic coatings, a two step-procedure was applied: the first step involved the synthesis of the Ga (III)-CS complex, followed by EPD from suitable solutions in an acetic acid–aqueous solvent. The influence of Ga (III) concentration on the stability of the suspensions was evaluated in terms of zeta potential. Fourier transform infrared (FTIR) and energy dispersive X-ray (EDX) spectroscopic analyses indicated the chelation of CS with Ga (III) within the coatings, while scanning electron microscopy (SEM) confirmed that no additional metallic gallium deposited during EPD. Furthermore, the results demonstrated that the wettability, mechanical properties, swelling ability, and enzymatic degradation of the coatings were affected by the quantity of Ga (III) ions. Colony forming unit (CFU) tests showed a strong synergistic effect between CS and Ga (III) in inhibiting Escherichia coli strain growth compared to control CS samples. An in vitro study with MG-63 cells showed that Ga (III)-containing coatings were not toxic after 24 h of incubation.

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Section: Introductionmentioning

confidence: 99%

Electrophoretic Deposition and Characterization of Functional Coatings Based on an Antibacterial Gallium (III)-Chitosan Complex

et al. 2020

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“…Several meta-analyses [ 19 – 21 ] were performed to evaluate the combination of IV and topical TXA in primary TKA. However, it may have some limitations and the conclusion might have the bias: First, as they included both TKA and THA in the analysis [ 19 , 20 ], they did not account for the difference in the type of surgery. It cannot draw meaningful conclusions, and we believed that stricter criteria need to be applied to determine the benefits of combining TXA in a meta-analysis.…”

Section: Introductionmentioning

confidence: 99%

The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Xiong

Liu

Zeng

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe combined administration of intravenous (IV) and topical tranexamic acid (TXA) in primary total knee (TKA) knee remains controversial. The purpose of this meta-analysis was to assess the efficacy and safety of combined administration of IV and topical TXA in primary TKA.MethodsPubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Google Search Engine and China National Knowledge Infrastructure databases were searched for randomized controlled trials (RCTs) were comparing the combined administration of IV and topical TXA following primary TKA. The primary outcomes were total blood loss, maximum hemoglobin drop, and deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The second outcomes were drainage volume and transfusion requirements. Data were analyzed using RevMan 5.3.ResultsA total of 6 RCTs involving 701 patients were included in the meta-analysis. The combined group provided lower total blood loss (MD − 156.34 mL, 95% CI, − 241.51 to − 71.18; P = 0.0003), drainage volume (MD − 43.54 mL, 95% CI, − 67.59 to − 19.48; P = 0.0004), maximum hemoglobin drop (MD − 0.56 g/dl, 95% CI, − 0.93 to − 0.19; P = 0.003) than IV TXA alone. No significant difference were found in terms of transfusion requirements (RR 0.48, 95% CI, 0.16 to 1.44; P = 0.19), DVT (RR 1.01, 95% CI, 0.14 to 7.12; P = 0.99) and PE (RR 0.33, 95% CI, 0.01 to 7.91; P = 0.49) between the two group. Subgroup analyses shows that the combined group was less total blood loss in non-tourniquet (P = 0.0008), topical TXA dose > 1.5 g (P < 0.00001) and number of IV TXA ≥ 2 doses (P = 0.005) of TXA compared with the IV group alone.ConclusionsThe available evidence indicates combined group were associated with lower total blood loss, drainage volume, and maximum hemoglobin drop. A similar transfusion requirement was found in both groups. Subgroup analyses demonstrates that total blood loss was less in patients with non-tourniquet, topical TXA dose > 1.5 g and number of IV TXA ≥ 2 doses of TXA. There was no increase the rates of DVT and PE.

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“…There is increasing political and community concern because multiple approaches have failed or struggled to control the spread of HCAIs, resulting in high morbidity and mortality due to AMR infections developed during hospital stays. [150][151][152][153][154][155] Strategies aimed at minimizing and controlling HCAIs comprise active surveillance cultures (ASCs), contact isolation of patients colonized with epidemiologically significant pathogens, and pre-emptive isolation of high-risk patients. 156 It has been suggested that ASCs of all or certain highrisk patients and placing them under contact precautions will help to curb or eliminate the multidrug-resistant organisms (MDROs) that can trigger HCAIs.…”

Section: Screening and Cohorting Patientsmentioning

confidence: 99%

<p>Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview</p>

Haque¹,

McKimm²,

Sartelli³

et al. 2020

RMHP

101

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Healthcare-associated infections (HCAIs) are a major source of morbidity and mortality and are the second most prevalent cause of death. Furthermore, it has been reported that for every one-hundred patients admitted to hospital, seven patients in high-income economies and ten in emerging and low-income economies acquire at least one type of HCAI. Currently, almost all pathogenic microorganisms have developed antimicrobial resistance, and few new antimicrobials are being developed and brought to market. The literature search for this narrative review was performed by searching bibliographic databases (including Google Scholar and PubMed) using the search terms: "Strategies," "Prevention," and "Healthcare-Associated Infections," followed by snowballing references cited by critical articles. We found that although hand hygiene is a centuries-old concept, it is still the primary strategy used around the world to prevent HCAIs. It forms one of a bundle of approaches used to clean and maintain a safe hospital environment and to stop the transmission of contagious and infectious microorganisms, including multidrug-resistant microbes. Finally, antibiotic stewardship also has a crucial role in reducing the impact of HCAIs through conserving currently available antimicrobials.

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

Cited by 63 publications

References 24 publications

Electrophoretic Deposition and Characterization of Functional Coatings Based on an Antibacterial Gallium (III)-Chitosan Complex

Electrophoretic Deposition and Characterization of Functional Coatings Based on an Antibacterial Gallium (III)-Chitosan Complex

The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

<p>Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview</p>

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