Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

Zhao, Wei; Zhang, Haojie

doi:10.1186/s13018-018-0948-1

Cited by 14 publications

(11 citation statements)

References 28 publications

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“…Using bone cement and screws, the prosthesis fixed to the bone and normal function of the patient's hip joint is reinstated [1][2][3] . THA can effectively relieve pain symptoms and improve the quality of life of patients with hip disease.…”

Section: Introductionmentioning

confidence: 99%

Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

Yang

Huang

et al. 2020

Orthopaedic Surgery

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Objective To compare the early rehabilitation effects of total hip arthroplasty (THA) with the direct anterior approach (DAA) versus the posterior approach (PA). Methods We searched PubMed, Embase, Web of Science, the Cochrane Library, and Google databases from inception to June 2019 to select studies that compared the DAA and PA for THA. Only randomized controlled trials (RCT) were included. Two researchers independently screened studies for inclusion, extracted data, and assessed the methodological quality. A meta‐analysis was conducted using RevMan 5.3 software provided by Cochrane Assisted Network. Results A total of 932 patients underwent THA. There were 467 cases in group DAA and 465 cases in group PA. There was a significant difference in the incidence of lateral femoral cutaneous nerve injury between DAA and PA groups (RR = 38.97, 95% CI: 7.89–192.57, P < 0.05). DAA was associated with less pain compared with PA [WMD = −0.65, 95% CI (−0.91–0.38), P < 0.05]. There was no significant difference in operation time, hospitalization stay, and intraoperative bleeding volume. Moreover, in supplementary data, the number of acetabular prostheses in Lewinnek's safety zones in DAA was more than that in the PA group (RR = 1.20, 95% CI [1.04–1.39], P < 0.05), and the time of discontinuation of walking aids in the DAA group was earlier than that in the PA group (WMD = −11.05, 95% CI [−17.79–4.31], P < 0.05). Conclusion The DAA total hip arthroplasty has comparable results with PA, with earlier postoperative functional recovery, less postoperative pain scores, and higher incidence of lateral femoral cutaneous nerve injury. The results need to be validated by large‐sample, high‐quality RCT studies, and long‐term follow‐up of complications.

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Section: Introductionmentioning

confidence: 99%

Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

Yang

Huang

et al. 2020

Orthopaedic Surgery

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“…Presently, the most common topical TXA administration routes are joint irrigation and installation into the standard drain, alternatively combined with epinephrine. [ 14 ] In clinical practice, topical irrigation doses of TXA range from 0.5 to 3 g in 20 to 100 mL saline. Lostak et al [ 15 ] administered 3 g of TXA in 100 mL saline topically to the bleeding bone bed before the implantation of final joint components, as well as before wound closure.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty

et al. 2021

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Background: Tranexamic acid (TXA) is an antifibrinolytic agent used to reduce bleeding in major surgical procedures. This study evaluates the efficacy and safety of the systemic and topical intra-articular administration of TXA in total hip arthroplasty (THA). Methods: Patients (N = 123) scheduled for primary unilateral THA were divided into 3 treatment groups: control group; TXA, systemic, repeated 1 g bolus; TXA, topically intra-articularly, 2 g in 50 mL saline. Primary readouts used were intra- and postoperative bleeding, transfusion requirement, postoperative hemoglobin levels and complications. Results: Both systemic and topical intra-articular TXA administrations decreased bleeding and transfusion requirements. Topical intra-articular use of TXA led to the reduction in intraoperative and postoperative bleeding and affected hemoglobin levels compared with control. Systemic administration of TXA led to a significant reduction of postoperative bleeding and transfusion rate compared with control and was not different in efficacy and complication incidence when compared to topical administration of TXA. Conclusions: The use of TXA to reduce blood loss and transfusion requirements in THA is an effective and safe concept in practice. The dose of 2 g TXA topically intra-articularly and a repeated bolus of 1 g TXA systematic led to lower intra- and postoperative bleeding and a significantly lower transfusion rate than the control group. Topical intra-articular TXA administration could be a reasonable alternative in high-risk patients.

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“…At present, a large number of studies report that TXA is safe and effective in hip and knee joint replacement, regardless of the mode of administration, intravenous, topical, or combination [12][13][14][15]. However, no study has reported on the intravenous infusion of TXA in the acetabulum in terms of its effect on blood loss during the perioperative period in these fractures.…”

Section: Discussionmentioning

confidence: 99%

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

Wang¹,

Yang²,

Zhu³

et al. 2020

Preprint

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Backgroud: some studys have reported that topical use of TXA can reduce perioperative blood loss in acetabular fracture surgery. We aim to investigate the effect of intravenous administration of tranexamic acid (TXA) on perioperative blood loss during acetabular fracture surgery Methods From January 2016 to May 2020, 85 patients undergoing surgical treatment with intravenous TXA administration for acetabular fractures at our department were retrospectively analyzed. The patients were divided into three groups according to dosage of TXA: Single treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery (n = 33), repeated treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery and intravenous infusion of TXA (10 mg/kg) at 3 h (n = 26), and multiple treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery and intravenous infusion of TXA (10 mg/kg) at 3 and 6 h (n = 26). Total blood loss, intraoperative blood loss, postoperative hemoglobin drop, surgery-related transfusion rate, postoperative thrombosis rate, and operation time were compared among these three groups Results Total blood loss, intraoperative blood loss, postoperative hemoglobin drop, and drainage volume in the single treatment group, repeated treatment group, and multiple treatment group were 932.7.0 ± 181.8 ml, 624.2 ± 138.7 ml, 32.2 ± 5.3 g/l, and 100.1 ± 30.1 ml; 843.4 ± 153.0 ml, 567.3 ± 144.1 ml, 27.6 ± 3.8 g/l, and 86.1 ± 42.2 ml; and 748.0 ± 145.2 ml, 521.1 ± 98.1 ml, 24.4 ± 4.4 g/l, and 64.8 ± 29.0 ml, respectively; the values were significantly different between groups (P < 0.05). The surgery-related blood transfusion rates in the single treatment, repeated treatment, and multiple treatment groups were 51.5% (17/33), 23.0% (6/26), 19.2% (5/26), respectively. There was no statistically significant difference in surgery-related blood transfusion rates between groups Conclusions Intravenous administration of TXA in acetabular fracture surgery can reduce total blood loss, intraoperative blood loss, and postoperative hemoglobin drop without increasing the risk of venous thrombosis. Multiple administrations before surgery, and at 3 h and 6 h during surgery are more effective than single and repeated administration

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Comparative effectiveness and safety of tranexamic acid plus diluted epinephrine to control blood loss during total hip arthroplasty: a meta-analysis

Cited by 14 publications

References 28 publications

Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

Direct Anterior Approach Versus Posterolateral Approach in Total Hip Arthroplasty: A Systematic Review and Meta‐analysis of Randomized Controlled Studies

Evaluation of efficacy and safety of systemic and topical intra-articular administration of tranexamic acid in primary unilateral total hip arthroplasty

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

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