Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement

Lacko, Marek

doi:10.5606/ehc.2017.54914

Cited by 19 publications

(9 citation statements)

References 20 publications

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“…Gianakos et al [12] published the latest meta-analysis on IA vs. IV in 2018, and it demonstrated the superiority of IA over IV administration. However, with the publication of 14 new randomized controlled trial (RCT) results thereafter [13][14][15][16][17][18][19][20][21][22][23][24][25][26], it is imperative to perform a new meta-analysis to corroborate or repudiate the conclusion of Gianakos et al, which is the purpose of our study.…”

Section: Introductionmentioning

confidence: 99%

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

Liu

Rai

et al. 2020

J Orthop Surg Res

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Background The optimal dosage and administration approach of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains controversial. In light of recently published 14 randomized controlled trials (RCTs), the study aims to incorporate the newly found evidence and compare the efficacy and safety of intra-articular (IA) vs. intravenous (IV) application of TXA in primary TKA. Methods PubMed, Embase, Web of Science, and Cochrane Library were searched for RCTs comparing IA with IV TXA for primary TKA. Primary outcomes included total blood loss (TBL) and drain output. Secondary outcomes included hidden blood loss (HBL), hemoglobin (Hb) fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time. Result In all, 34 RCTs involving 3867 patients were included in our meta-analysis. Significant advantages of IA were shown on TBL (MD = 33.38, 95% CI = 19.24 to 47.51, P < 0.001), drain output (MD = 28.44, 95% CI = 2.61 to 54.27, P = 0.03), and postoperative day (POD) 3+ Hb fall (MD = 0.24, 95% CI = 0.09 to 0.39, P = 0.001) compared with IV. There existed no significant difference on HBL, POD1 and POD2 Hb fall, blood transfusion rate, perioperative complications, length of hospital stay, and tourniquet time between IA and IV. Conclusion Intra-articular administration of TXA is superior to intravenous in primary TKA patients regarding the performance on TBL, drain output, and POD3+ Hb fall, without increased risk of perioperative complications. Therefore, intra-articular administration is the recommended approach in clinical practice for primary TKA.

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Section: Introductionmentioning

confidence: 99%

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

Liu

Rai

et al. 2020

J Orthop Surg Res

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“…About comorbid conditions such as myocardial infarction history, cerebrovascular events, or hormonal replacement therapy there is still concern. [12] The most important limitation of our study is that four different surgeons performed the surgeries. Although all surgeons have extensive experience in the field of knee replacement surgery, individual differences could affect perioperative blood loss.…”

Section: Discussionmentioning

confidence: 97%

“…Following iv application, TA is rapidly dispersed into synovial fluid. [12] Many publications show that TA administration causes significant reduction in the blood loss. [29][30][31][32] Our study showed that the average amount of blood loss in the TA-receiving group was 656.7±57.4 ml and the blood loss in the non-TA Perioperative blood loss and drainage blood loss 0-24 hours were statistically higher than TXA + group in TXA -group.…”

Section: Discussionmentioning

confidence: 99%

The effect of single high dose preoperative intravenous tranexamic acid administration to reduce blood loss in patients with primary total knee replacement

et al. 2018

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K nee replacement surgery is one of the most common procedures for knee osteoarthritis. This procedure can lead to significant blood loss, and the blood transfusion rate is high. In 34% of patients who underwent total knee replacement (TKR), perioperative blood transfusions are being performed at least once. [1] Allogeneic blood transfusion is associated with a variety of risks such as transfusion reaction, volume overload of the heart, and inhibition of immune system. [2-4] Blood transfusion increases hospitalization cost. [5] In clinical practice, different protective measures such as autologous blood transfusion have been used to reduce postoperative blood transfusion rates. [6-8] Other methods for prevention of perioperative blood loss include preoperative administration of erythropoietin, preoperative administration of iron supplements, normovolemic hemodilution, controlled hypotension, tourniquet use, and application of antifibrinolytic agents. [9-12] Tranexamic acid (TA) is a lysine analog that blocks plas-Objectives: This study aimed to analyze the efficacy of single-dose tranexamic acid (TA) 20 mg/kg preoperatively to reduce blood loss in patients undergoing total knee replacement (TKR). Methods: A total of 387 patients (82 males, 305 females) undergoing TKR between January 2014 and December 2018 were included in the study. The T + group was administrated intravenous (iv) TA 20 mg/kg 20 min before the skin incision. We determined perioperative blood loss, the amount of drainage postoperative 24 h, the amount of drainage after postoperative 24-48 h, total volume of drains, total volume of blood loss, postoperative hemoglobin and hematocrit levels, and amount of total blood transfusion. Results: In terms of demographic data, no statistically significant difference was observed between the groups. Perioperative blood loss and total volume of blood loss was found statistically higher in T − group compared to T + group. Postoperatively, the mean hemoglobin and hematocrit levels of T − group were statistically significantly lower than T + group. Conclusion: A single 20 mg/kg iv TA administration before TKR reduces bleeding during surgery and within 24 h postoperatively.

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“…5,6 Since then, many clinical trials have been done to assess the effectiveness of tranexamic acid. 6,7 There is a known increased risk of a thromboembolic event when used intravenously in patients with chronic renal failure and those with known previous ischaemic events and heart disease. 8 Intra-articular (IA) administration provides a maximum concentration at the bleeding site with limited systemic influence.…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

Naqshaband¹,

Taqi²,

Ashraf³

et al. 2021

J Fatima Jinnah Med Univ

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Background: The goal of this research was to assess the effectiveness and safety of intra-articular tranexamic acid (TA) with intravenous (IV) TA in reducing perioperative blood loss, the severity of early postoperative problems, and venous thromboembolism in patients who have had a primary unilateral cemented total knee replacement. Patients and methods: This comparative study was undertaken using a non-probability purposive sampling technique at the Department of Orthopedic Surgery, King Edward Medical University / Mayo Hospital, Lahore, from July 1st, 2018 to October 30th, 2019. A total of number 71 patients, aged 35 to 75 years, who underwent unilateral cemented total knee replacement for advanced knee osteoarthritis were included in the study. Patients who had known allergic reactions to tranexamic acid, risk factors of thromboembolism, severe kidney and heart diseases, and blood clotting disorders were excluded. The patients were divided into two groups, A and B. Pre-operatively, patients in Group A were given intraarticular tranexamic acid (3000mg). In Group B, intravenous tranexamic acid (10mg/kg) was given pre-operatively. Outcome parameters studied were drained blood (DB), level of hemoglobin (Hb), blood transfusion (BT), and hematocrit (Hct) after 48 hours of surgery and compared with the preoperative value. Data was entered and analyzed using SPSS version 21.0. Independent sample T-test was applied to compare the hematocrit and hemoglobin difference in the two groups, and the P-value was taken less than 0.05 as significant. Results: Out of the total 36 patients in Group A, there were 20 (55.5%) males and 16 (44.4%) females, while amongst 35 patients in Group B, there were 21 (60%) males and 14 (40%) females. The mean preoperative Haemoglobin (Hb) in Group A was 13.9+1.2 and 13.8+0.9 in Group B (p = 0.44). The mean postoperative Hb in Group A was 12.11±2.47 and 11.24 ± 3.52 in Group B (p = 0.002). The mean variation of Hct in Group A was 4.49 and 6.82 in Group B (p = 0.001). Conclusion: Intra-articular tranexamic acid during total knee joint replacement is a viable alternative to the established intravenous tranexamic acid with statistically significant high postoperative hemoglobin and hematocrit levels.

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Comparison of intravenous and intra-articular tranexamic acid in reducing blood loss in primary total knee replacement

Cited by 19 publications

References 20 publications

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

Intra-articular vs. intravenous administration: a meta-analysis of tranexamic acid in primary total knee arthroplasty

The effect of single high dose preoperative intravenous tranexamic acid administration to reduce blood loss in patients with primary total knee replacement

Comparison of outcomes between intra-articular tranexamic acid versus intravenous tranexamic acid in unilateral knee joint replacement

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