Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty

Huang, Zeyu; Xie, Xiaowei; Li, Lingli; Huang, Qiang; Ma, Jun; Shen, Bin; Kraus, Virginia B.; Pei, Fuxing

doi:10.2106/jbjs.16.01525

Cited by 121 publications

(177 citation statements)

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“…We believed that it might be a consequence of absence of blood loss into the drain. TXA use is a much debated topic in the field of joint replacement . In agreement with previous studies, we found TXA use to be associated with a reduced risk of ALBT .…”

Section: Discussionsupporting

confidence: 92%

“…TXA use is a much debated topic in the field of joint replacement . In agreement with previous studies, we found TXA use to be associated with a reduced risk of ALBT . Owing to these findings, currently drains and tourniquets are not routinely used in our orthopedic center's daily practice.…”

Section: Discussionsupporting

confidence: 90%

“…As reported by several meta-analyses, drain use was also found to be a risk factor for ALBT. [32][33][34][35] We believed that it might be a consequence of absence of blood loss into the drain. TXA use is a much debated topic in the field of joint replacement.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

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Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Huang

Xie

et al. 2018

Transfusion

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“…In addition, multiple doses of intravenous and topical TXA without a tourniquet had less hidden blood loss than those treated with a tourniquet . Recent studies showed that hemophiliacs treated with TXA had less perioperative blood loss, hidden blood loss, transfusion rate, a lower ratio of postoperative knee swelling, and less postoperative joint pain after total knee/hip arthroplasty . In vitro spiking experiments performed by Rea et al showed that that a more efficient treatment may be obtained if TXA is combined with factor concentrates to treat patients with hemophilia.…”

Section: Discussionmentioning

confidence: 99%

“…24 Recent studies showed that hemophiliacs treated with TXA had less perioperative blood loss, hidden blood loss, transfusion rate, a lower ratio of postoperative knee swelling, and less postoperative joint pain after total knee/ hip arthroplasty. 25,26 In vitro spiking experiments performed by Rea et al 27 showed that that a more efficient treatment may be obtained if TXA is combined with factor concentrates to treat patients with hemophilia. Taken together, our in vitro and mice results, in association with previously published data in orthopedic surgery, strongly suggest that the combined use of TXA and factor concentrates can be translated to the prophylactic setting in patients with hemophilia.…”

Section: Discussionmentioning

confidence: 99%

Hemostatic effect of tranexamic acid combined with factor VIII concentrate in prophylactic setting in severe hemophilia A: A preclinical study

Janbain

Enjolras

Bordet

et al. 2020

Journal of Thrombosis and Haemostasis

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Background Hemophilia is characterized by a compromised hemostatic response with delayed development of a clot and the formation of clots that are vulnerable to fibrinolysis. We proposed to study, in vitro and in factor VIII knockout mice (FVIII‐KO), whether hemostasis is improved with the addition of tranexamic acid (TXA) to low FVIII plasma concentrations. Methods In vitro, blood samples from adults with severe hemophilia‐A, spiked to final concentrations of 0‐3‐10 and 30IU.dL−1 of FVIII, were studied with and without TXA 0.1 mg/mL using thromboelastography in the presence of tPA (ROTEM‐tPA), thrombin generation (TG) assay, and scanning electron microscopy. FVIII‐KO mice received prophylaxis before trauma, to obtain circulating plasma FVIII at 3 IU.dL−1 or FVIII 3IU.dL−1 + TXA 0.1 mg/mL. After trauma‐induced knee joint bleeding, magnetic resonance imaging, histological analysis, and tail clip assay were used to compare hemostastic efficacy of the two prophylactic strategies. Results A dose‐dependent improvement of TG was observed with recombinant FVIII (rFVIII) alone (P = .024). As expected, no effect of TXA on TG capacity was observed. Fibrin fiber diameters were significantly decreased with TXA + rFVIII compared to rFVIII, suggesting a stronger fibrin network. Surprisingly, ROTEM‐tPA was normalized with TXA alone. In FVIII‐KO mice, blood loss after tail clip was lower after prophylaxis with rFVIII + TXA compared to rFVIII, with no statistical significance (P = .15). However, MRI results and histological analysis of knee joints showed that the addition of TXA significantly decreased joint bleeding (P = .022). Conclusion Our results suggest a potential benefit of TXA when used in combination with FVIII in prophylactic settings.

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Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

et al. 2021

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IMPORTANCE Tranexamic acid (TXA) is an efficient antifibrinolytic agent; however, concerns remain about the potential adverse effects, particularly vascular occlusive events, that may be associated with its use.OBJECTIVE To examine the association between intravenous TXA and total thromboembolic events (TEs) and mortality in patients of all ages and of any medical disciplines.DATA SOURCE Cochrane Central Register of Controlled Trials and MEDLINE were searched for eligible studies investigating intravenous TXA and postinterventional outcome published between 1976 and 2020.STUDY SELECTION Randomized clinical trials comparing intravenous TXA with placebo/no treatment. The electronic database search yielded a total of 782 studies, and 381 were considered for full-text review. Included studies were published in English, German, French, and Spanish. Studies with only oral or topical tranexamic administration were excluded.DATA EXTRACTION AND SYNTHESIS Meta-analysis, subgroup and sensitivity analysis, and meta-regression were performed. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES Vascular occlusive events and mortality.RESULTS A total of 216 eligible trials including 125 550 patients were analyzed. Total TEs were found in 1020 (2.1%) in the group receiving TXA and 900 (2.0%) in the control group. This study found no association between TXA and risk for total TEs (risk difference = 0.001; 95% CI, −0.001 to 0.002; P = .49) for venous thrombosis, pulmonary embolism, venous TEs, myocardial infarction or ischemia, and cerebral infarction or ischemia. Sensitivity analysis using the risk ratio as an effect measure with (risk ratio = 1.02; 95% CI, 0.94-1.11; P = .56) and without (risk ratio = 1.03; 95% CI, 0.95-1.12; P = .52) studies with double-zero events revealed robust effect size estimates. Sensitivity analysis with studies judged at low risk for selection bias showed similar results. Administration of TXA was associated with a significant reduction in overall mortality and bleeding mortality but not with nonbleeding mortality. In addition, an increased risk for vascular occlusive events was not found in studies including patients with a history of thromboembolism. Comparison of studies with sample sizes of less than or equal to 99 (risk difference = 0.004; 95% CI, −0.006 to 0.014; P = .40), 100 to 999 (risk difference = 0.004; 95% CI, −0.003 to 0.011; P = .26), and greater than or equal to 1000 (risk difference = −0.001; 95% CI, −0.003 to 0.001; P = .44) showed no association between TXA and incidence of total TEs. Meta-regression of 143 intervention groups showed no association between TXA dosing and risk for venous TEs (risk difference, −0.005; 95% CI, −0.021 to 0.011; P = .53).CONCLUSIONS AND RELEVANCE Findings from this systematic review and meta-analysis of 216 studies suggested that intravenous TXA, irrespective of dosing, is not associated with increased risk of any TE. These results help clarify the incidence of...

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Intravenous and Topical Tranexamic Acid Alone Are Superior to Tourniquet Use for Primary Total Knee Arthroplasty

Abstract: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Cited by 121 publications

References 42 publications

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Analysis of a large data set to identify predictors of blood transfusion in primary total hip and knee arthroplasty

Hemostatic effect of tranexamic acid combined with factor VIII concentrate in prophylactic setting in severe hemophilia A: A preclinical study

Association of Intravenous Tranexamic Acid With Thromboembolic Events and Mortality

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