Effects of Different Applications of Tranexamic Acid on Perioperative Blood Transfusion Rate and Postoperative Pain in Unilateral Total Knee Arthroplasty

Zhang, Xiaodong; Ma, Desi; Pan, Jiadong; Liang, Wen-Yew

doi:10.1007/s12325-020-01596-4

Cited by 5 publications

(7 citation statements)

References 18 publications

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“…Several studies have investigated the safety and efficacy of TXA in reducing blood loss in TKA through the three abovementioned administration routes. It is concluded that both topical and intravenous TXA are effective and equally safe in reducing blood loss and transfusion rates 29–32 . But there is controversy over whether the combination of intravenous and topical application of TXA has a better outcome in reducing blood loss than topical or intravenous TXA alone.…”

Section: Discussionmentioning

confidence: 99%

Combination of Intravenous and Intra‐Articular Application of Tranexamic Acid and Epsilon‐Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Zheng

et al. 2022

Orthopaedic Surgery

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Objective There were limited randomized controlled trials (RCTs) of epsilon‐aminocaproic acid (EACA) versus tranexamic acid (TXA) in total knee arthroplasty (TKA). The aim of the study was to compare the efficacy and safety of TXA and EACA in the combination of intravenous (IV) and intra‐articular (IA) administration on reducing blood loss in patients following primary TKA. Methods From January 2020 to January 2021, a total of 181 patients undergoing a primary unilateral TKA were enrolled in this prospective randomized controlled trial. Patients in the TXA group (n = 90) received 20 mg/kg of intravenous TXA preoperatively, 1 g of intra‐articular TXA intraoperatively, and three doses of 20 mg/kg intravenous TXA at 0, 3, 6 h postoperatively. Patients in the EACA group (n = 91) received 120 mg/kg of intravenous EACA preoperatively, 2 g of intra‐articular EACA intraoperatively, and three doses of 40 mg/kg intravenous EACA at 0, 3, 6 h postoperatively. The primary outcomes were total blood loss (TBL), transfusion rates and drop of hemoglobin (HB) level. The secondary outcomes included postoperative hospital stays and postoperative complications. The chi‐square tests and Fisher's exact tests were utilized to compare categorical variables, while the independent‐samples t‐tests and Mann–Whitney tests were used to compare continuous variables. Results The patients who received TXA averaged less TBL than the patients who received EACA (831.83 ml vs 1065.49 ml, P = 0.015), and HB drop in TXA group was generally less than that of EACA group on postoperative day 1 and 3 (20.84 ± 9.48 g/L vs 24.99 ± 9.40 g/L, P = 0.004; 31.28 ± 11.19 vs 35.46 ± 12.26 g/L, P = 0.047). The length of postoperative stays in EACA group was 3.66 ± 0.81 day, which is longer than 2.62 ± 0.68 day in TXA group (P < 0.001). No transfusions were required in either group. The risk of nausea and vomiting in TXA group was significantly higher than that in EACA group (11/90 vs 0/91, P < 0.01). Conclusion Although the TBL and HB drop were slightly greater in EACA group, these results were not clinically important, given that no transfusions were required. EACA could be an alternative to TXA, especially for patients with severe nausea and vomiting after using TXA postoperatively. Further studies are needed to adjust dosage of EACA to make better comparison of the two drugs.

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Section: Discussionmentioning

confidence: 99%

Combination of Intravenous and Intra‐Articular Application of Tranexamic Acid and Epsilon‐Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Zheng

et al. 2022

Orthopaedic Surgery

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“…A study by Peng et al in 2021 showed that in TKA, the IA administration of TXA significantly reduced total and occult blood loss without reducing drainage compared to IV ( 53 ). In 2021, Zhang et al in a prospective study showed that intraoperative spraying and drug-soaked gauze to cover the wound combined with local injection into the articular cavity significantly reduced intraoperative blood loss, postoperative drainage, postoperative blood loss, total blood loss, and the incidence of deep vein thrombosis in patients undergoing TKA than intravenous drip combined with local injection into the articular cavity ( 54 ). This seemed to predict that IA administration of TXA will be the best choice in the TIA.…”

Section: Discussionmentioning

confidence: 99%

The application of tranexamic acid in joint arthroplasty: A 20-year bibliometric analysis

Zhang

Zhao²,

Huang³

et al. 2022

Front. Public Health

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BackgroundWith the arrival of the era of the aging population, the amount of joint arthroplasty surgery keeps rising, and the articles related to the application of tranexamic acid (TXA) in joint arthroplasty (we called the application of tranexamic acid in joint arthroplasty as TIA in this study) also show a blowout growth. Therefore, we conducted a bibliometric analysis of TIA-related publications to identify the main research trends and hot spots in this field in the last 20 years.MethodsIn this study, publications in the field of TIA from January 1, 2002 to December 31, 2021 were searched in the Web of Science Core Collection (WoSCC). A total of 1,013 publications were evaluated for specific characteristics with Microsoft Excel software, CiteSpace, VOSviewer, and Online Analysis Platform of Literature Metrology (http://bibliometric.com/).ResultsA total of 1,013 TIA-related articles were included in this study, and the number of articles in this field has increased yearly over the past 20 years. The USA and China dominated in the field of TIA. The Sichuan University published the most TIA-related articles among all the institutions. Of all the authors, Professor Pei was the most productive author with 64 articles. The lack of international cooperation was a significant problem in this field during the past 20 years. Furthermore, the results of the co-citation analysis and citation bursts analysis revealed that the safety and effectiveness of TIA and the optimal use strategy were the main trends and hotspots for the current and future.ConclusionThis bibliometric study reviewed the evolution trend of TIA research, and identified the countries, institutions, authors and journals that have made significant contributions to this field in the past 20 years, as well as the limitations and deficiencies in this field. In addition, this study revealed that the effectiveness and safety of TIA and the optimal use strategy was the current or future research trend and hotspot in this field.

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“…TKA has been more and more widely used for it can effectively relieve the pain of severe KOA and improve the joint function, with the gradual improvement of people's quality of life, the continuous improvement of prosthesis design, and the continuous improvement of the operator's operation technology [24]. However, its development has been affected by the postoperative anemia and complications caused by excessive blood loss and which reduced the satisfaction of patients in clinical practice [1,25]. Although allogeneic blood transfusion can replenish excessive blood loss and its safety has been greatly improved in recent years, it could still lead to prolonged LOS, increased medical costs, and a variety of complications, such as immune response, and infection, which is not conducive to the rehabilitation of patients and brings a certain economic burden to the society [25][26][27].…”

Section: Discussionmentioning

confidence: 99%

“…Knee osteoarthritis (KOA) is a chronic bone and joint disease and related to age. Its prevalence is increasing year by year due to the continuous progress of population aging [ 1 ]. The data [ 2 ] showed the proportion of doctor-diagnosed KOA is estimated to be 15.7% in the population aged ≥45 by the year 2032.…”

Section: Introductionmentioning

confidence: 99%

Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the efficacy and safety of performing primary unilateral total knee arthroplasty (TKA) in the “Si hour-period” meaning 09:00 a.m. to 11:00 a.m. (one of the 12 two-hour periods into which the day was traditionally divided, each being given the name of one of the 12 earthly branches), compared with the “Wei hour-period” (13:00–15:00). Methods. Patient documentations were studied for those who underwent a primary unilateral TKA performed by the same surgical team with a tourniquet between January 2018 and January 2021 at our medical center. Eighty-four patients were enrolled and assigned into group A (in Si hour-period) and group B (in Wei hour-period). The main outcomes were total blood cell loss (TBL), hidden blood loss (HBL), visible blood loss (VBL), maximum hemoglobin (Hb) drop, and transfusion rate. Secondary outcomes were length of hospital stay (LOS), postoperative femorotibial mechanical axis (FTMA), FTMA correction, platelet count, plasma D-dimer (D-D), prothrombin time (PT), international normalized ratio (INR), and the incidence of postoperative complications. Results. Group A showed statistical significance lower at the mean TBL, the mean HBL, and the maximum Hb drop (95% CI: −352.8 to −46.1, P = 0.011 , 95% CI: −348.0 to −40.1, P = 0.014 , and 95% CI: −9.5 to −0.7, P = 0.023 , respectively) after TKA than group B. The postoperative platelet count of group A was more significant than that of group B (95% CI:3.1 to 52.9, P = 0.028 ). The VBL, transfusion rate, the LOS, postoperative FTMA, FTMA correction, plasma D-D, PT, INR, and the incidence of postoperative complications (wound complications, calf muscular vein thrombosis, infection, pulmonary embolism, and deep vein thrombosis) were similar between the two groups ( P > 0.05 , respectively). Conclusion. Our study shows that blood loss can be reduced when TKA is performed in the “Si hour-period,” which may be due to increasing platelet count, and postoperative complications did not increase, compared with the Wei hour-period. We recommend that the selective operation, such as TKA, should be performed in the “Si hour-period” in clinical practice between the two hour-period.

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Effects of Different Applications of Tranexamic Acid on Perioperative Blood Transfusion Rate and Postoperative Pain in Unilateral Total Knee Arthroplasty

Cited by 5 publications

References 18 publications

Combination of Intravenous and Intra‐Articular Application of Tranexamic Acid and Epsilon‐Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

Combination of Intravenous and Intra‐Articular Application of Tranexamic Acid and Epsilon‐Aminocaproic Acid in Primary Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

The application of tranexamic acid in joint arthroplasty: A 20-year bibliometric analysis

Perioperative Blood Loss Can Be Reduced If Total Knee Arthroplasty Was Performed in the Si Hour-Period, Compared with the Wei Hour-Period: A Retrospective Cohort Study

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