Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Georgiev, G; Tanchev, P; Zheleva, Zlatka; Kinov, Plamen

doi:10.1016/j.jot.2017.12.006

Cited by 23 publications

(21 citation statements)

References 63 publications

(82 reference statements)

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“…Luo ZY et al [21] had mentioned of a probability of periprosthetic infection due to contamination occurring during needle aspiration and when the drug is being diluted but if all aseptic precautions are taken this can be easily eliminated. We agree with Georgiev GP et al [30] that topical tranexamic acid could be a reasonable alternative in patients with contraindications for intravenous application of tranexamic acid.…”

Section: Complicationssupporting

confidence: 91%

Intravenous versus topical tranexamic acid as a blood conservation intervention in hip joint replacement surgeries

Basoya¹,

Vd²

2019

Int. J. Orthop. Sci.

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Background: Hip arthroplasty is associated with substantial blood loss intraoperatively as well as postoperatively. The objective of the present experimental study was to compare the effectiveness of topical tranexamic acid with intravenous tranexamic acid in reducing blood loss in hip joint replacement surgeries. Methods: The experimental study comprised of 60 cases undergoing hip joint replacement surgeries who were randomly assigned to the intravenous group (n=30) and topical group (n=30). Tranexamic acid was used in the dose of 15 mg/kg. All Patients undergoing hip joint replacement surgeries and preoperative Hb > 10 g/dl for males and > 9 g/dl for females were included in this study. Patients having a known history of thromboembolic disease, myocardial infarction, cerebrovascular disease, angina, coagulopathy, any liver or renal disease or any other source of active bleeding were excluded from the study. Results: In hemiarthroplasty the blood loss in the topical and intravenous group was 547.8±178.11ml and 617.73±192.51ml with a p value of 0.298. The haemoglobin and PCV was 2.01±1.18 mg/dl, 6.22±4.08% and 2.41±1.74 mg/dl, 6.69±5.03 with a p value of 0.521 and 0.865. Similarly in total hip replacement the blood loss in the topical and intravenous group was 620.80±160.33ml and 745.30±152.67ml with a significant p value of 0.046. The haemoglobin and PCV was 2.75±1.60 mg/dl, 6.15±7.05% and 2.80±1.84 mg/dl, 8.52±5.47 with a p value of 0.534 and 0.214. Conclusion:Tranexamic acid can be given by intravenous or topical route as both the routes are equally effective in reducing the intraoperative blood loss.

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Section: Complicationssupporting

confidence: 91%

Intravenous versus topical tranexamic acid as a blood conservation intervention in hip joint replacement surgeries

Basoya¹,

Vd²

2019

Int. J. Orthop. Sci.

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“…In orthopedic surgery, the use of systemically and topically applied TXA has been expanding over the past years, with mounting evidence for relevant reductions in posttraumatic and perioperative blood loss and transfusion requirements [ 2 , 20 ]. However, little evidence exists regarding direct effects of TXA on bone cells, including osteoblasts, osteoclasts, and macrophages.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Promotes Murine Bone Marrow-Derived Osteoblast Proliferation and Inhibits Osteoclast Formation In Vitro

Baranowsky

Appelt

Tseneva

et al. 2021

IJMS

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Despite modern surgical trauma care, bleeding contributes to one-third of trauma-related death. A significant improvement was obtained through the introduction of tranexamic acid (TXA), which today is widely used in emergency and elective orthopedic surgery to control bleeding. However, concerns remain regarding potential adverse effects on bone turnover and regeneration. Therefore, we employed standardized cell culture systems including primary osteoblasts, osteoclasts, and macrophages to evaluate potential effects of TXA on murine bone cells. While osteoblasts derived from calvarial digestion were not affected, TXA increased cell proliferation and matrix mineralization in bone marrow-derived osteoblasts. Short-term TXA treatment (6 h) failed to alter the expression of osteoblast markers; however, long-term TXA stimulation (10 days) was associated with the increased expression of genes involved in osteoblast differentiation and extracellular matrix synthesis. Similarly, whereas short-term TXA treatment did not affect gene expression in terminally differentiated osteoclasts, long-term TXA stimulation resulted in the potent inhibition of osteoclastogenesis. Finally, in bone marrow-derived macrophages activated with LPS, simultaneous TXA treatment led to a reduced expression of inflammatory cytokines and chemokines. Collectively, our study demonstrates a differential action of TXA on bone cells including osteoanabolic, anti-resorptive, and anti-inflammatory effects in vitro which suggests novel treatment applications.

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“…Peak plasma concentrations of TXA are obtained in 5–15 min for intravenous infusion, and the biological half-life is about 2 hours; correspondingly, the operation time of OWHTO is usually within 2 hours [ 47 – 49 ]. Topical TXA can provide a high local concentration, arrest bleeding directly, and reduce blood loss rapidly [ 48 ]. Based on the above analysis, the patients in our study received intravenous combined with topical administration of TXA.…”

Section: Discussionmentioning

confidence: 99%

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy

Chen

Wang

Zhu

et al. 2020

BioMed Research International

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The purpose of this study was to investigate the efficacy of tranexamic acid (TXA) in patients undergoing open-wedge high tibial osteotomy (OWHTO). Patients from August 2018 to May 2020 were retrospectively studied. Clinical data were obtained including gender, age, height, weight, body mass index (BMI), smoking, alcohol consumption, hypertension, diabetes, history of aspirin, prepostoperative hematocrit (Hct) and hemoglobin (Hb), thrombotic events, blood transfusion requirement, hospital length of stay, size of osteotomy gap, and wound complications such as wound hematoma and infection. 52 patients were enrolled in the tranexamic acid group (TA group), and 48 patients were enrolled in the nontranexamic acid group (NTA group); there were no significant differences between both groups in terms of gender, age, BMI, preoperative Hb, size of osteotomy gap, incidence of smoking, alcohol consumption, hypertension, diabetes, history of aspirin, thrombotic events, blood transfusion requirement, and wound hematoma and infection. The mean hospital length of stay was 9.4 ± 1.0 days in the TA group and 11.0 ± 1.2 days in the NTA group ( P < 0.001 ), the blood loss was 296.0 ± 128.7 ml in the TA group and 383.3 ± 181.3 ml in the NTA group ( P < 0.05 ), and the postoperative Hb level was 120.8 ± 15.0 g/l in the TA group and 109.5 ± 13.8 g/l in the NTA group ( P < 0.001 ). In conclusion, the administration of TXA is beneficial to patients undergoing OWHTO via decreasing hospital length of stay, reducing blood loss, and maintaining higher postoperative Hb levels.

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Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Cited by 23 publications

References 63 publications

Intravenous versus topical tranexamic acid as a blood conservation intervention in hip joint replacement surgeries

Intravenous versus topical tranexamic acid as a blood conservation intervention in hip joint replacement surgeries

Tranexamic Acid Promotes Murine Bone Marrow-Derived Osteoblast Proliferation and Inhibits Osteoclast Formation In Vitro

Tranexamic Acid Is Beneficial to Patients Undergoing Open-Wedge High Tibial Osteotomy

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