Intravenous Combined with Topical Administration of Tranexamic Acid in Primary Total Hip Arthroplasty: A Randomized Controlled Trial

Zeng, Yi; Si, Haibo; Shen, Bin; Yang, Jing; Zhou, Zongke; Kang, Pengde; Pei, Fuxing

doi:10.1111/os.12287

Cited by 21 publications

(9 citation statements)

References 39 publications

(52 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The method of anaesthesia was decided by anaesthetists. To reduce bleeding, a preoperative dose of 15 mg/kg tranexamic acid (TXA) was applied intravenously before incision, and another 1 g TXA was given topically (Nakamura et al., 2014; Zeng et al, 2017). All patients received local infiltration analgesia based on a ropivacaine‐based cocktail (100 ml containing 200 mg ropivacaine, 0.5 mg epinephrine and 0.9% normal saline).…”

Section: Methodsmentioning

confidence: 99%

Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty

Chen

Liu

Zhang

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

Aims and objectives:To evaluate the efficacy and safety of a comprehensive protocol for constipation prevention.Background: Constipation is a common problem for patients undergoing total hip arthroplasty (THA), yet sparse evidence is available to guide constipation prevention after THA. Design: Randomised controlled superiority clinical trial.Methods: This randomised controlled study was carried out according to the Consolidated Standards of Reporting Trials (CONSORT). A total of 80 THA patients were randomised to receive only preoperative education about lifestyle or the combination of education with postoperative abdominal massage and polyethylene glycol 4,000 (Forlax®). Efficacy outcomes included rates of postoperative constipation and enema rescue, as well as time to first postoperative defecation and readmission within 30 days. Safety outcomes were number and type of adverse events.Results: Patients who received combination treatment showed a significantly lower rate of postoperative constipation during hospitalisation than patients who received only preoperative education (25% versus 55%), and they showed a significantly lower rate of enema rescue (12.5% versus 40%). Many more patients receiving combination treatment experienced their first defecation within two postoperative days than patients who received only preoperative education (62.5% versus 35.9%). In contrast, the two groups were similar in terms of constipation rate on postoperative days 15 and 30, rate of readmission within 30 days and rate of postoperative adverse events. Conclusions:These results suggest that our comprehensive protocol can relieve constipation after THA, reduce the need for enema rescue and shorten time to first defecation without sacrificing safety. More work is needed to optimise and develop this protocol further.Relevance to clinical practice: Constipation is a distressing problem that frequently occurs after THA. This study confirmed that a comprehensive protocol including preoperative education, postoperative abdominal massage and polyethylene glycol 4,000 can effectively relieve constipation after THA without sacrificing safety.

show abstract

Section: Methodsmentioning

confidence: 99%

Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty

Chen

Liu

Zhang

et al. 2020

Journal of Clinical Nursing

View full text Add to dashboard Cite

show abstract

“…The inhibition of local fibrinolytic activity helps prevent fibrin clot dissolution and increases its volume and strength at the raw surgical surfaces, enhancing microvascular hemostasis [44]. In addition, TXA has lower systemic absorption.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems. Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P<0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P<0.05), 2.8 vs 3.3 (POD4, P<0.05), and 2.1 vs. 2.6 (PO6W, P<0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups. Conclusion To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group. Trial registration The trial was registered in the Chinese Clinical Trial Registry (ChiCTR-TRC-1800017754, retrospectively registered from 2018 to 01-01).

show abstract

“…Poeran et al [26] conducted a retrospective study of 870,000 patients with complete hip/knee replacement for 6 consecutive years in 510 hospitals in the United States, finding that the incidence of deep venous thrombosis after using TXA was 0.4%, while the incidence was 0.5% in the group not using TXA. In addition, the majority of publications showed that TXA has an acceptable safety profile without increased risk of VTE [12,[27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%

Effect of tranexamic acid on symptomatic venous thromboembolism in patients undergoing primary total knee arthroplasty

Peng¹,

Wang²,

Weng³

et al. 2020

aoms

View full text Add to dashboard Cite

Introduction: This study aimed to investigate the effect of tranexamic acid (TXA) with sequential routine anticoagulation on postoperative symptomatic venous thromboembolism (VTE) in patients undergoing primary total knee arthroplasty (TKA). Material and methods: This was a prospective study with randomized trials. From January 2013 to May 2015, 1880 patients undergoing primary TKA were enrolled in this study. Seven hundred and twenty patients who received TXA injection were included in the TXA group while 1160 patients who received placebo injection were included in the control group. Patients in the TXA group were treated with intravenous TXA or topical intravenous TXA, and all received sequential routine anticoagulation 12 h after the operation. We extracted data of patients' sex, age, primary diagnoses, and comorbidities that could potentially affect the prevalence rate of VTE. To discuss the risk factors of symbolic VTE, comparisons were made within the TXA group between patients with symbolic VTE and non-symbolic VTE. Logistic regression analysis was performed to analyze the concurrent effects of various factors on the prevalence rate of postoperative VTE. Results: Thigh perimeter was not closely associated with TXA injection. Within the TXA group, 24 (3.3%) patients had perioperative symptomatic VTE, 16 (2.2%) deep vein thrombosis (DVT) and 8 (1.1%) pulmonary embolism. High body mass index (BMI), low fibrinogen (Fbg) and simultaneous bilateral TKA were significant risk factors in both univariate analysis and multivariate analysis. Conclusions: Increased BMI, low Fbg, and simultaneous bilateral TKA could act as risk factors for postoperative symptomatic VTE treated with TXA.

show abstract

Intravenous Combined with Topical Administration of Tranexamic Acid in Primary Total Hip Arthroplasty: A Randomized Controlled Trial

Cited by 21 publications

References 39 publications

Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty

Randomised controlled trial of a comprehensive protocol for preventing constipation following total hip arthroplasty

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Effect of tranexamic acid on symptomatic venous thromboembolism in patients undergoing primary total knee arthroplasty

Contact Info

Product

Resources

About