Comparison of the Effects of Intravenous and Oral Tranexamic Acid on Perioperative Hemoglobin Levels During Total Knee Arthroplasty

Pathan, Sophia; Cruz, Joseph E.; Curtin, Patrick

doi:10.1177/1060028019876077

Cited by 5 publications

(4 citation statements)

References 9 publications

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“…These results do not support our hypothesis that the sequential administration of IV and oral TXA would reduce Hb drop after TKA. Previous studies have reported TXA to be effective for reducing blood loss after TKA [6][7][8]21 . However, the optimal TXA administration method remains controversial.…”

Section: Discussionmentioning

confidence: 99%

“…Various methods of TXA administration that increase the effects of TXA have been studied [7][8][9][10][11] , including combining different routes of administration 12,13 . It has been reported that the combined administration of intravenous (IV) TXA and intraarticular TXA injections or oral TXA is superior to a single route of administration without increasing complications 12,14,15 .…”

mentioning

confidence: 99%

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Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty

Chang

Shin

Yoon

et al. 2021

Journal of Bone and Joint Surgery

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Background: Tranexamic acid (TXA) is typically discontinued on the day of total knee arthroplasty (TKA). However, bleeding may persist for several days. We sought to determine whether sequential administration of intravenous (IV) and oral TXA could reduce hemoglobin (Hb) drop more than IV TXA alone. We also wanted to determine whether the use of additional oral TXA increased the rate of complications of deep vein thrombosis (DVT) or symptomatic pulmonary embolism (PE).Methods: This prospective, randomized controlled trial included 141 patients. We compared the Hb drop, estimated blood loss (EBL), and transfusion rate of patients receiving IV TXA alone (group IV, n = 48) to those of patients who received IV TXA followed by oral TXA for 2 days (group 2D, n = 46) or 5 days (group 5D, n = 47). IV TXA was administered 10 minutes prior to the tourniquet release and 3 hours after the first IV TXA administration. Computed tomography (CT) was performed on postoperative day 6 to identify radiographic evidence of DVT. We also assessed the prevalence of symptomatic DVT and PE.Results: There were no differences in maximal Hb drop, Hb drops measured at each time point, EBL, or transfusion rate among the 3 groups. The mean maximal Hb drop was 3.5 g/dL in group IV, 3.2 g/dL in group 2D, and 3.4 g/dL in group 5D. The mean EBL was 999.9 mL in group IV, 886.4 mL in group 2D, and 972.5 mL in group 5D. One patient in each group required a transfusion. There were no differences in the prevalence of radiographic evidence of DVT or symptomatic DVT. Symptomatic DVT occurred in 3 patients in group IV and 2 patients in group 5D. One patient in group IV developed a symptomatic PE. Conclusions:Although there was no increase in the complication rate, the sequential administration of oral TXA for up to 5 days after IV TXA did not decrease Hb drop. Therefore, our findings suggest that sequential use of oral and IV TXA is not recommended.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty

Chang

Shin

Yoon

et al. 2021

Journal of Bone and Joint Surgery

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“…1), thus delaying the degradation of the fibrin clot (fibrinolysis), reducing blood loss, and the need for transfusions. 9,15,16,19,20,[22][23][24][25] Current literature supports the use of TXA in patients undergoing TKA, as reducing blood loss will minimize complications and hospital costs. 14,15,17,21,[23][24][25][26][27][28] Despite some initial fear that it might induce thrombotic events, the widespread use of TXA has confirmed its safety, corroborated by many studies, although no consensus has been reached on doses or forms of administration in TKA.…”

mentioning

confidence: 99%

“…Total knee arthroplasty (TKA) is an orthopaedic surgery procedure performed worldwide, with excellent results in reducing pain and restoring functionality in patients with end-stage knee osteoarthritis. [1][2][3][4][5][6][7][8][9][10][11] Conventional instrumentation (CI), the standard option for TKA, uses intramedullary and/or extramedullary alignment systems that rely too much on visual references which can lead even an experienced surgeon to produce undesired postoperative axes. 5,8,10 These devices not only complicate the workflow and prolong surgery time but also can increase blood loss and the risk of fat embolism, as they are more invasive.…”

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confidence: 99%

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

et al. 2021

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Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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Comparison of the Effects of Intravenous and Oral Tranexamic Acid on Perioperative Hemoglobin Levels During Total Knee Arthroplasty

Cited by 5 publications

References 9 publications

Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty

Effect of Sequential Intravenous and Oral Tranexamic Acid on Hemoglobin Drop After Total Knee Arthroplasty

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

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