Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty

Jang, Bob; Kao, Mark; Böhm, M.; Harris, Ian A.; Chen, Darren B.; MacDessi, Samuel J.

doi:10.1177/230949901402200205

Cited by 23 publications

(30 citation statements)

References 14 publications

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“…The TXA also decreased the number of the packed red blood cell transfusion per patient. Routes of administration of TXA are different in the literature such as intra-articular, 17 intravenous, and oral, 18 with no literature showing one route to be superior to another.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients

Burleson

Güler

Banos

et al. 2015

Clin Appl Thromb Hemost

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Section: Discussionmentioning

confidence: 99%

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients

Burleson

Güler

Banos

et al. 2015

Clin Appl Thromb Hemost

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“…The remaining 41 articles are included in this article as either background or supportive material (n ¼ 25) 2, [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][25][26][27][28][29][30][31] or as the quantitative meta-analysis (n ¼ 16). 1,3,23,24,[32][33][34][35][36][37][38][39][40][41][42][43] The study selection is shown in the PRISMA flowchart (►Fig. 1).…”

Section: Study Selectionmentioning

confidence: 99%

“…Eight of the 16 studies included in the meta-analysis were blinded randomized controlled trials, CEBM Level I, 32,34,36,[38][39][40]42,43 1 study was a nonblinded randomized controlled trial, CEBM Level II, 41 and the remaining 7 studies were case-controlled trials, CEBM Level III 1,3,23,24,33,35,37 (►Table 1). Sample sizes ranged from 24 to 373 patients receiving unilateral TKAs, a total of 2,610 patients (1,339 IA-TXA and 1,271 placebo) were enrolled in the 16 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…TXA was injected into the joint capsule in seven studies consisting of 491 IA-TXA TKAs, 24,35,[37][38][39][40]43 and in the other nine studies consisting of 848 IA-TXA TKAs, the knee was either irrigated or bathed with TXA before capsule closure. 1,3,23,[32][33][34][35]41,42 The dosage and concentration of TXA used for intra-articular injection or irrigation was quite varied, two studies examined the effect of dosage. 40,42 Nine studies used postsurgical drains; these were often clamped post-TKA.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…40,42 Nine studies used postsurgical drains; these were often clamped post-TKA. 24,32,[35][36][37][38][39][40][41] Transfusion trigger was usually defined to be post-TKA hemoglobin less than 7 or 8 g/dL for nonsymptomatic patients and less than 8 or 10 g/dL for patients who were symptomatic for anemia or who had comorbidities. The most common method of calculating total blood loss was the use of the Nadler's formula incorporating hemoglobin balance.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis

Moskal

Capps²

2017

J Knee Surg

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Total knee arthroplasty (TKA) is associated with an increased need for blood transfusions and thus an increase in risks associated with blood transfusion such as transfusion reactions, infections, fluid overload, and altered mental status. Tranexamic acid (TXA) is an antifibrinolytic medication that can reduce perioperative blood loss in TKA. However, the best method of delivery has not been defined although topical intra-articular TXA (IA-TXA) may have a theoretical advantage as it is applied directly when and where it is needed to control bleeding. Blinded and nonblinded randomized controlled trials and case-controlled trials published since 2010 were found using database searches. Data were extracted and analyzed with the goal of discovering through meta-analysis if IA-TXA reduces blood loss, blood transfusions, and without increasing adverse events, especially thromboembolic events, compared with placebo. Blood loss from suction drains and calculated total blood loss were significantly lower in the IA-TXA group. The frequency of blood transfusion and the number of units of blood transfused were significantly lower in the IA-TXA group. The risk of adverse events was not increased for IA-TXA versus placebo. Topical IA-TXA in primary, unilateral TKA successfully reduces blood loss and the frequency of blood transfusions. In addition, it does not appear to increase the risk of thromboembolic adverse events. There is need for further research to determine the optimal dosage and the preferred delivery system of IA-TXA in TKA.

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Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty Decreases the Rate of Post-operative Blood Transfusions in People with Hemophilia: A Retrospective Case-Control Study

2019

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Background: Blood transfusion rates after total knee arthroplasty (TKA) in patients without hemophilia have diminished with the use of a standardized multimodal blood loss prevention method (MBLPM) that includes intraarticular tranexamic acid (TXA) (MBLPM-TXA). However, the topic has not been addressed in people with hemophilia. Questions/Purposes: Our aim was to investigate whether the MBLPM-TXA prevents blood loss in patients with hemophilia A who undergo TKA, thereby decreasing the need for post-operative blood transfusion. Methods: This retrospective case-control comparative study involved 30 TKA patients who had a severe degree of hemophilia A without inhibitions: one group treated with the MBLPM-TXA (n = 15) and a second group treated without it (n = 15). In all cases, the pre-operative hemoglobin level was greater than 13 g/dL. Results: The MBLPM-TXA group had a transfusion rate of zero, whereas 46.6% of the patients (seven of 15) in the non-MBLPM-TXA group needed transfusion. Conclusion: This retrospective case-control study showed that the use of an MBLPM-TXA in patients with hemophilia A who underwent TKA was effective in reducing rates of transfusion. We recommend its use.

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Intra-Articular Injection of Tranexamic Acid to Reduce Blood Loss after Total Knee Arthroplasty

Abstract: Intra-articular administration of TXA is effective in reducing blood loss after TKA, without increasing the risk of VTE.

Cited by 23 publications

References 14 publications

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients

Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients

Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty: Meta-analysis

Intra-articular Tranexamic Acid in Primary Total Knee Arthroplasty Decreases the Rate of Post-operative Blood Transfusions in People with Hemophilia: A Retrospective Case-Control Study

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