Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610‐patient consecutive case series

Pitta, Michael; Zawadsky, Mark W.; Verstraete, Richard; Rubinstein, Aaron

doi:10.1111/trf.13354

Cited by 28 publications

(21 citation statements)

References 23 publications

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“…During the pharmacist intervention phase, simple cost‐benefit analysis showed moderate savings and the benefit‐to‐cost ratio of 1.77:1 for theinstitution because of decreased blood transfusion, which was in accord with a study of perioperative patient blood management . TXA is a relatively inexpensive medication, and because of the net reduction in transfusion, TXA treatment can lead to cost reductions.…”

Section: Discussionsupporting

confidence: 56%

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Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Zhou

Bao

2019

Basic Clin Pharma Tox

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Background: Total knee arthroplasty (TKA) is associated with blood loss and an increased risk of transfusion. Guidelines for antifibrinolytic drug tranexamic acid (TXA) treatment in TKA patients are available. We evaluated the effects of anticoagulant pharmacist intervention on perioperative blood conservation treatment in TKA patients. Methods: In a retrospective, observational experimental study, patients admitted for TKA were allocated into the control or pharmacist intervention group. In the intervention phase, multiple interventions of TXA treatment based on guidelines were implemented. The primary endpoint was blood loss. Other outcome included postoperative haemoglobin and haematocrit levels, allogeneic blood transfusion, cost savings and safety. Results: A total of 177 patients were included (88 and 89 in the control and intervention group, respectively). In the intervention group, 24.72% orders of TXA dosage, 20.22% orders of drug choice, 26.97% orders of TXA timing and 30.34% orders of TXA administration manner were adjusted. Eighty-nine (100%) patients received blood conservation therapy compared with 21 (23.86%) patients in the control group (P < 0.001). Total blood loss was 1133.31 ± 627.08 mL in the control group compared with 604.34 ± 459.09 mL in the intervention group (P < 0.001). Postoperative drops in haemoglobin and haematocrit in the control group were greater than in the intervention group (P < 0.001). The rate of allogeneic blood transfusion was 40.91% in the control group compared with 21.35% in the intervention group (P = 0.01). Pharmacist intervention was conducted to cost savings resulting from reduced transfusion, but with comparable safety profile. Conclusions: Anticoagulant pharmacist intervention on blood conservation treatment of TKA patients leads to favourable clinical and economic outcome.allogeneic blood transfusion, blood conservation, pharmacist intervention, tranexamic acid, venous thromboembolism Abbreviations: BMI, body mass index; DVT, deep vein thrombosis; Hb, haemoglobin; Hct, haematocrit; TKA, total knee arthroplasty; TXA, tranexamic acid; VTE, venous thromboembolism.

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Section: Discussionsupporting

confidence: 56%

“…Total knee arthroplasty (TKA) is associated with considerable perioperative blood loss and an increased rate of the need of transfusion . Blood loss often increases the risk of transfusion reactions and healthcare costs.…”

Section: Introductionmentioning

confidence: 99%

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Zhou

Bao

2019

Basic Clin Pharma Tox

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“…Akgül et al [ 34 ] reported 20 mg/kg IV-TXA given before the skin incision in the primary TKA could decrease the total blood loss from 1166.42 mL to 634.03 mL and reduce the drainage volume from 640.74 mL to 311.11 mL. Pitta et al [ 35 ] performed another retrospective study involving 610 patients during 4 years, they reported the administered IV of TXA resulted in a significant decrease by 9.4% in blood loss compared to the control group in TKA, and no significantly different was found in the incidence of DVT. Compared with the safety concerns with intravenous administration, topical TXA has been a growing interest to prevent bleeding.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Xiong

Liu

Zeng

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe combined administration of intravenous (IV) and topical tranexamic acid (TXA) in primary total knee (TKA) knee remains controversial. The purpose of this meta-analysis was to assess the efficacy and safety of combined administration of IV and topical TXA in primary TKA.MethodsPubMed, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, Google Search Engine and China National Knowledge Infrastructure databases were searched for randomized controlled trials (RCTs) were comparing the combined administration of IV and topical TXA following primary TKA. The primary outcomes were total blood loss, maximum hemoglobin drop, and deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The second outcomes were drainage volume and transfusion requirements. Data were analyzed using RevMan 5.3.ResultsA total of 6 RCTs involving 701 patients were included in the meta-analysis. The combined group provided lower total blood loss (MD − 156.34 mL, 95% CI, − 241.51 to − 71.18; P = 0.0003), drainage volume (MD − 43.54 mL, 95% CI, − 67.59 to − 19.48; P = 0.0004), maximum hemoglobin drop (MD − 0.56 g/dl, 95% CI, − 0.93 to − 0.19; P = 0.003) than IV TXA alone. No significant difference were found in terms of transfusion requirements (RR 0.48, 95% CI, 0.16 to 1.44; P = 0.19), DVT (RR 1.01, 95% CI, 0.14 to 7.12; P = 0.99) and PE (RR 0.33, 95% CI, 0.01 to 7.91; P = 0.49) between the two group. Subgroup analyses shows that the combined group was less total blood loss in non-tourniquet (P = 0.0008), topical TXA dose > 1.5 g (P < 0.00001) and number of IV TXA ≥ 2 doses (P = 0.005) of TXA compared with the IV group alone.ConclusionsThe available evidence indicates combined group were associated with lower total blood loss, drainage volume, and maximum hemoglobin drop. A similar transfusion requirement was found in both groups. Subgroup analyses demonstrates that total blood loss was less in patients with non-tourniquet, topical TXA dose > 1.5 g and number of IV TXA ≥ 2 doses of TXA. There was no increase the rates of DVT and PE.

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“…[16][17][18] This has also been shown to translate to a reduced LOS for patients. 19 Similarly, in studies where patients have received dexamethasone, shorter stays in hospital have been noted. 20 This reflects the data obtained in our study, where the significant difference can be explained in part by the antiemetic and opioid-sparing effects of dexamethasone.…”

Section: Discussionmentioning

confidence: 96%

Enhanced recovery programmes for lower limb arthroplasty in the UK

Nagra

Hamilton

Strickland

et al. 2017

annals

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Introduction Enhanced recovery programmes (ERPs) reduce patient morbidity and mortality, and provide significant cost savings by reducing length of stay. Currently, no uniform ERP guidelines exist for lower limb arthroplasty in the UK. The aim of this study was to identify variations in ERPs and determine adherence to local policy. Methods Hospitals offering elective total knee arthroplasty (TKA) and total hip arthroplasty (THA) (23 and 22 centres respectively) contributed details of their ERPs, and performed an audit (15 patients per centre) to assess compliance. Results Contrasting content and detail of ERPs was noted across centres. Adherence to ERPs varied significantly (40-100% for TKA, 17-94% for THA). Analysis identified perioperative use of dexamethasone, tranexamic acid and early mobilisation for TKA, and procedures performed in teaching hospitals for THA as being associated with a reduced length of stay. Conclusions This study highlights variation in practice and poor compliance with local ERPs. Given the proven benefits of ERPs, evidence-based guidelines in the context of local skillsets should be established to optimise the patient care pathway.

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Intravenous administration of tranexamic acid effectively reduces blood loss in primary total knee arthroplasty in a 610‐patient consecutive case series

Cited by 28 publications

References 23 publications

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

Effect of pharmacist intervention on blood conservation therapy in total knee arthroplasty: A retrospective, observational study

The efficacy and safety of combined administration of intravenous and topical tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Enhanced recovery programmes for lower limb arthroplasty in the UK

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