Effect of Tranexamic Acid on Transfusion Rates Following Total Joint Arthroplasty

Evangelista, Perry J.; Aversano, Michael W.; Koli, Emmanuel; Hutzler, Lorraine; Inneh, Ifeoma A.; Bosco, Joseph; Iorio, Richard

doi:10.1016/j.ocl.2016.12.001

Cited by 31 publications

(18 citation statements)

References 10 publications

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“…TXA is a well-tolerated drug that has been widely administered in total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgeries. [ 13 – 15 ] The results of our meta-analysis indicated that administration of TXA was associated with a reduction in the need for transfusion by 3.11% (RR = 0.45; 95% CI 0.21–0.99; P = .046). Shemshaki et al [ 16 ] reported that TXA could decrease the need for transfusion by 22.2% in TKA patients.…”

Section: Discussionmentioning

confidence: 92%

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Wang

Yuan

et al. 2017

Medicine

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Background:The purpose of this meta-analysis is to compare the efficacy of tranexamic acid (TXA) versus placebo after a total shoulder arthroplasty (TSA).Methods:In April 2017, a systematic computer-based search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, and Google. Studies comparing TXA versus placebo in reducing blood loss after TSA were included. The endpoints were the need for transfusion, blood loss in drainage, hemoglobin drop, and total blood loss. Stata 12.0 software was used for the meta-analysis.Results:Six studies involving a total of 637 patients met the inclusion criteria. The meta-analysis revealed that, compared with control groups, treatment with TXA could decrease the need for transfusion (P < .00001), blood loss in drainage (P = .000), hemoglobin drop (P = .001), and total blood loss (P = .000).Conclusion:TXA can decrease the need for transfusion as well as total blood loss in TSA patients. There was a negative correlation between the TXA dose and the need for transfusion and blood loss in drainage. Because the administration route and the dose of TXA were different, more studies are needed in order to identify the optimal dose and route.

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Section: Discussionmentioning

confidence: 92%

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Wang

Yuan

et al. 2017

Medicine

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“…Some studies showed that multiple boluses of oral or IV TXA postoperatively were effective and safe [22,[45][46][47]. Compared with non-pharmacologic hemostatic agents and even with another pharmacological antifibrinolytic (epsilon-aminocaproic acid), TXA is the most costeffective medicine to minimize perioperative blood loss in THA [31,48,49]. Zhao et al [27] showed that the cost of blood transfusion was much lower with oral TXA (US$ 137 total patients) than with intravenous TXA (US$ 273 total patients) or without application of TXA (US$ 1230 total patients).…”

Section: Discussionmentioning

confidence: 99%

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Wang

et al. 2020

Arthroplasty

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Background: Total hip arthroplasty is associated with substantial blood loss which can lead to postoperative anemia. The purpose of this systematic review and meta-analysis was to compare efficacy and safety of oral tranexamic acid (TXA) and intravenous TXA. Methods: PubMed, EMBASE, and Cochrane Library were searched from inception until December 2019. A combined searching strategy of subject words and random words was adopted. Only clinical randomized controlled trials were included. The comparisons were made with regard to total blood loss, hemoglobin drop, transfusion rate, and postoperative thromboembolic complications including deep vein thrombolism (DVT) and pulmonary embolism (PE). The meta-analysis was conducted by using the Review Manager 5.3, and bias evaluation was performed based on the Cochrane Handbook 5.1.0. Results: In this meta-analysis, five randomized controlled trials were included. The results showed that there were no significant differences between the oral TXA group and intravenous TXA group concerning total blood loss [mean difference (MD) =3.01, 95% confidence interval (95% CI): − 43.90 to 49.92, p = 0.90], hemoglobin drop (MD = 0.05, 95% CI: − 0.10 to 0.20, p = 0.50) and transfusion rate of allogeneic blood [risk ratio (RR) =1.09, 95% CI: 0.46 to 2.62, p = 0.84]. No significant difference was found in the incidence of thromboembolic events (RR = 1.71, 95% CI: 0.71 to 4.16, p = 0.97). Conclusions: Compared with intravenous TXA, oral TXA is equally able to reduce total blood loss, hemoglobin drop, and transfusion requirement for total hip arthroplasty. It is a lower-cost method that does not increase the incidence of thromboembolic events.

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“…Evangelista et al [15] compared total joint replacement patients in a cohort study and reported a reduction in blood transfusion from 22.7% to 11.9% and from 19.4% to 7.0% following hip and knee joint replacements, respectively. Similar findings have also been reported after prophylactic administration of TXA for other orthopaedic procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, estimated savings with regard to blood transfusion costs may be lower in England. Estimated savings of $3,083 (approximately £2,386) and $2,582 (approximately £1,998) per case have been reported for THR and TKR, respectively, with TXA use in the US [15].…”

Section: Discussionmentioning

confidence: 99%

Primary lower limb joint replacement and tranexamic acid: an observational cohort study

et al. 2018

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BackgroundThis work aimed to evaluate the efficacy and safety of routine tranexamic acid (TXA) use in elective orthopaedic lower limb joint replacement surgery.MethodsThis retrospective cohort study included all primary hip or knee replacement procedures by a single surgeon over a 6-year period. TXA was introduced during the study period as part of an enhanced recovery after surgery strategy.ResultsOf the 673 procedures, 446 cases (66.3%) received TXA. The median length of stay was 5 days (2-69) and 6 days (3-28) for the TXA and control groups, respectively (P < .001). Blood transfusion was required for 28 (6.3%) of the TXA cases versus 40 (17.6%) controls (P < .001). Complication rates were similar irrespective of TXA status. At multivariate analysis, TXA was significantly and independently associated with fewer blood transfusions (hazard ratio 0.309, 95% confidence interval: 0.168-0.568, P < .001), with a number needed to treat of 9 cases. TXA use was estimated to save between £67.89 and £155.90 per case.ConclusionsRoutine prophylactic TXA administration for elective primary hip and knee replacement reduces the likelihood of postoperative transfusion with a number needed to treat of 9. Cost savings may be as high as £155.90 per case, and no safety concerns were noted.

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Effect of Tranexamic Acid on Transfusion Rates Following Total Joint Arthroplasty

Cited by 31 publications

References 10 publications

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

The efficacy of tranexamic acid in reducing blood loss in total shoulder arthroplasty

Comparison of oral and intravenous tranexamic acid in total hip arthroplasty: a systematic review and meta-analysis

Primary lower limb joint replacement and tranexamic acid: an observational cohort study

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