Efficacy and safety of oral tranexamic acid in total knee arthroplasty

Guo, Peipei; He, Zhiyong; Wang, Yanhua; Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Li, Zirong; Cheng, Liming

doi:10.1097/md.0000000000010587

Cited by 36 publications

(27 citation statements)

References 29 publications

(72 reference statements)

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“…Previously, orthopaedic surgeons were hesitant to adopt TXA into practice because of poorly supported links to venous thromboembolic events, acute renal failure, and stroke. Contraindications to TXA use has been a topic of much debate, and large-scale database studies have found no increased complication risk when TXA was administered to patients with relative contraindications [59][60][61][62]. Despite a comparatively small sample size, our study substantiated prior findings as it showed no increase in overall complication rate with TXA use.…”

Section: Discussionsupporting

confidence: 84%

Tourniquet and tranexamic acid use in total knee arthroplasty

et al. 2020

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Background: There is no consensus on how tourniquet and tranexamic acid (TXA) use in total knee arthroplasty (TKA) affect blood transfusion rates and total blood loss. We compared outcome measures and transfusion rates after TKA, with and without the use of tourniquet and TXA. Methods: A retrospective study of 477 consecutive patients undergoing primary TKA between 2008 and 2013 was performed. There were 243 in the tourniquet-assisted (TA) and 234 in the tourniquetunassisted (TU) group. Operative times, hemoglobin levels, blood transfusion rates, complications, and length of stay were assessed. Subanalysis was performed on those patients receiving and not receiving TXA within the TU group. Results: Mean operative duration was 66.4 minutes in the TA group and 87.5 minutes in the TU group (P < .0001). Mean postoperative drop in hemoglobin was greater in TU group (3.1 g/dL vs 2.8 g/dL, P ¼ .002). The transfusion rate was 9.5% in TA compared with 11.5% in TU patients (P ¼ .46) with comparable mean units transfused (2.6 vs 2.2, P ¼ .30). There was no difference in wound infection (P ¼ .82) and total complication rates (P ¼ .27) between groups. Those patients given TXA had a lower hemoglobin drop (2.6 g/ dL vs 3.3 g/dL, P ¼ .04) with similar transfusion (13.3% vs 11%, P ¼ .61) and complication (P ¼ .95) rates. Conclusions: TU TKA had a greater operative duration and postoperative drop in hemoglobin than TA TKA. However, transfusion rates were similar between groups. TXA use reduced the operative decrease in hemoglobin with no effect on complication or transfusion rates.

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Section: Discussionsupporting

confidence: 84%

Tourniquet and tranexamic acid use in total knee arthroplasty

et al. 2020

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“…A recent clinical trial compared the use of topical and intravenous tranexamic and aminocaproic acid versus placebo, and the results of the studies investigating the use of oral TXA in joint replacement surgeries 42 were very similar to our study results. 43 To our knowledge, no previous studies have examined oral aminocaproic acid; however, we acknowledge that the variations in methodology, application techniques, different doses of TXA and ε-ACA and different methods to calculate blood loss account for the heterogeneity among studies, making it difficult to compare their results. In the present climate of tightening health care budgets and debate surrounding fiscal austerity, the implications of increasing demand for TKA have led to intense discussion regarding the cost-effectiveness of a new method of antifibrinolytic administration.…”

Section: Discussionmentioning

confidence: 99%

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial

et al. 2019

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Total primary knee replacement results in significant postoperative bleeding. There are reports that 20 to 50% of the patients require a blood transfusion, which has been related to many complications, resulting in the search for strategies to reduce bleeding. The use of oral antifibrinolytics is becoming a low cost and safe way of achieving this goal. The hypothesis of this study was that the use of oral aminocaproic acid could provide similar results to the use of oral tranexamic acid (TXA). The purpose was to compare the effects of oral aminocaproic acid as a hemostatic agent versus the use of oral TXA administered in multiple doses pre and postsurgery in patients undergoing total primary knee replacement. We enrolled 92 patients that were randomly divided into two groups: received three doses of aminocaproic acid (2,000 mg per dose) or three doses of oral TXA (1,300 mg per dose). The drugs were administered according to the following schedule: 2 hours before surgery and 6 and 12 hours after surgery. The variables that were analyzed to compare the effectiveness of the hemostatic agents were total blood loss; hidden blood loss; external blood loss; transfusion rate; intraoperative blood loss; decreases in hemoglobin and hematocrit values; surgical drainage output; visual analogue scale; and surgical complications. There were no significant differences between any of the study variables for the group receiving oral aminocaproic acid and the group receiving oral TXA (p > 0.05), with the exception of patients who received TXA, who presented with more adverse events (p = 0.04). Our study showed that the use of oral aminocaproic acid was similar to its counterpart TXA regarding the evaluated parameters. Although patients who received TXA presented an average of 140 mL less blood loss than patients in the ε-ACA group, the difference did not appear to be clinically important, the transfusion rate was very low, and there were no between-group differences in postoperative complications.

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“…30 Although concerns regarding possible thromboembolic risk with tranexamic acid therapy have been expressed, recent systematic reviews have failed to demonstrate any significant increased risk. [32][33][34] DDAVP is a synthetic analog of vasopressin that stimulates endothelial cell secretion of stored VWF into the plasma. 35 Consequently, DDAVP can be used to transiently increase plasma VWF levels in some patients with VWD.…”

Section: Treatment Options For Patients With Low Vwfmentioning

confidence: 99%

How I treat low von Willebrand factor levels

Lavin

O’Donnell

2019

Blood

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Partial quantitative deficiency of plasma von Willebrand factor (VWF) is responsible for the majority of cases of von Willebrand disease (VWD), the most common inherited human bleeding disorder. International consensus guidelines recommend that patients with reduced plasma VWF antigen (VWF:Ag) levels and bleeding phenotypes be considered in 2 distinct subsets. First, patients with marked reductions in plasma VWF levels (<30 IU/dL) usually have significant bleeding phenotypes and should be classified with “type 1 VWD.” In contrast, patients with intermediate reduced plasma VWF levels (in the range of 30-50 IU/dL) should be considered in a separate category labeled “low VWF levels.” These patients with low VWF commonly display variable bleeding phenotypes and often do not have VWF gene sequence variations. Because the pathophysiology underlying low VWF levels remains largely undefined, diagnosis and management of these patients continue to pose significant difficulties. In this article, we present a number of clinical case studies to highlight these common clinical challenges. In addition, we detail our approach to establishing a diagnosis in low VWF patients and discuss strategies for the management of these patients in the context of elective surgery and pregnancy.

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Efficacy and safety of oral tranexamic acid in total knee arthroplasty

Cited by 36 publications

References 29 publications

Tourniquet and tranexamic acid use in total knee arthroplasty

Tourniquet and tranexamic acid use in total knee arthroplasty

First Comparative Study of the Effectiveness of the Use of Tranexamic Acid against ε-Aminocapróic Acid via the Oral Route for the Reduction of Postoperative Bleeding in TKA: A Clinical Trial

How I treat low von Willebrand factor levels

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