Intravenous Tranexamic Acid and Lower Limb Arthroplasty—A Randomised Controlled Feasibility Study

Painter, Tom; Daly, David; Kluger, Roman; Rutherford, A.; Ditoro, A.; Grant, Cliff; Howell, Simon

doi:10.1177/0310057x1804600407

Cited by 13 publications

(14 citation statements)

References 22 publications

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“…Finally, all three of the previous studies evaluating TXA in acetabular fracture surgery found no difference in rates of VTE [12][13][14], which is further corroborated by this cohort. TXA use has been shown to reduce transfusion rates by 8-23% in total knee arthroplasty [18][19][20][21] and by 11-28% in total hip arthroplasty [22][23][24][25]. However, a previous report in total hip arthroplasty found that TXA did not impact the extent of bone bleeding [26].…”

Section: Discussionmentioning

confidence: 99%

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Wadhwa

Tigchelaar

Chen

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Tranexamic acid (TXA) reduces need for transfusion in total joint arthroplasty, though findings in acetabular surgery are conflicting. We compared outcomes after acetabular fracture surgery with or without perioperative intravenous (IV) TXA administration. Methods We performed a retrospective review of 305 patients with acetabular fractures that underwent open reduction and internal fixation (ORIF). Eighty-nine patients received TXA, and 216 did not. The primary outcome was rates of intraoperative and postoperative allogeneic blood transfusion. Results Baseline demographics and characteristics were similar. Time from injury to surgery and estimated blood loss were comparable. Operative time (p < 0.01) and intraoperative IV fluids (p < 0.01) were greater in the non-TXA group. The proportion of patients who received blood transfusion and mean units transfused intraoperatively and postoperatively did not differ. Mean differences in preoperative and postoperative hemoglobin and hematocrit, hospital length of stay, and perioperative complications also did not differ. In a multivariable regression model, age 60-70 years, Charlson Comorbidity Index, Injury Severity Score, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approaches and intraoperative transfusion requirement were independently associated with postoperative transfusion. Conclusion In this study, perioperative IV TXA did not decrease blood loss, need for transfusion, or improve in-hospital outcomes of acetabular fracture surgery. Age 60-70, CCI, ISS, and fracture patterns likely to bleed were independently associated with intraoperative transfusion. Anterior surgical approach and need for intraoperative transfusion were independently associated with postoperative transfusion. Further prospective trials are warranted to confirm these findings

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Section: Discussionmentioning

confidence: 99%

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Wadhwa

Tigchelaar

Chen

et al. 2021

Eur J Orthop Surg Traumatol

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“…The "Tranexamic Acid in Lower Limb Arthroplasty" (TALLAS) pilot trial was a feasibility study for a larger multi-centre trial to investigate the e cacy and safety of TXA in patients over 45 years of age, undergoing lower-limb arthroplasty [4]. In this double-blind randomised controlled trial, TXA was administered at a dose of 15 mg/kg and rate of 50 mg/min intravenously at skin incision (for total hip replacement) or just prior to tourniquet release (for total knee replacement) and repeated at 8 and 16 h post-operatively.…”

Section: Tallas Feasibility Study Design and Patientsmentioning

confidence: 99%

Tranexamic Acid Alters The Immunophenotype of Phagocytes After Lower Limb Surgery

Draxler

Hanafi

Zahra

et al. 2021

Preprint

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Introduction: Tranexamic acid (TXA) is an antifibrinolytic agent frequently used in elective surgery to reduce blood loss. We recently found it also acts as a potent immune-modulator in patients undergoing cardiac surgery.Methods: Patients undergoing lower limb surgery were enrolled into the “Tranexamic Acid in Lower Limb Arthroplasty” (TALLAS) pilot study. The cellular immune response was characterised longitudinally pre- and post-operatively using full blood examination (FBE) and comprehensive immune cell phenotyping by flowcytometry. Red blood cells and platelets were determined in the FBE and levels of T cell cytokines and the plasmin-antiplasmin complex determined using ELISA.Results: TXA administration increased the proportion of circulating CD141+ conventional dendritic cells (cDC) on post-operative day (POD) 3. It also reduced the expression of CD83 and TNFR2 on classical monocytes and levels of circulating IL-10 at the end of surgery (EOS) time point, whilst increasing the expression of CCR4 on natural killer (NK) cells at EOS, and reducing TNFR2 on POD-3 on NK cells. Red blood cells and platelets were decreased to a lower extent at POD-1 in the TXA group, representing reduced blood loss. Discussion: In this investigation we have extended our examination on the immunomodulatory effects of TXA in surgery by also characterising the end of surgery time point and including B cells and neutrophils in our immune analysis, elucidating new immunophenotypic changes in phagocytes as well as NK cells. This study enhances our understanding of TXA-mediated effects on the haemostatic and immune response in surgery, validating changes in important functional immune cell subsets in orthopaedic patients.

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“…With the potential indications for perioperative TXA expanding there is a need for large RCTs to determine the safety and effectiveness of TXA in noncardiac surgery. 23 However, to gauge feasibility and optimise the design and value of large, pragmatic trials it is essential to first ascertain current practice and beliefs regarding perioperative TXA administration. We therefore undertook a survey of Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA).…”

Section: Introductionmentioning

confidence: 99%

A survey of anaesthetists’ use of tranexamic acid in noncardiac surgery

Painter

McIlroy

Myles

et al. 2019

Anaesth Intensive Care

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Major bleeding in noncardiac surgery is common and associated with serious complications. The antifibrinolytic agent tranexamic acid (TXA) reduces bleeding and may reduce the risk of these complications. TXA also may have immunomodulatory effects that could reduce surgical site infection. Clinical trials of TXA in noncardiac surgery have been insufficiently powered to evaluate its efficacy and safety. Therefore, large randomised controlled trials of its use in noncardiac surgery are required. To ensure that future clinical trials are feasible and acceptable, we undertook a survey of Fellows of the Australian and New Zealand College of Anaesthetists (ANZCA). Our aims were to ascertain current patterns of TXA administration and to assess the acceptability of randomising patients to intravenous TXA or placebo. A 12-item survey was electronically mailed to 1001 ANZCA Fellows. Two hundred and eighty nine responses were received and analysed (response rate 29%). Ninety-eight percent of respondents had used intravenous TXA in noncardiac surgery; 67% give TXA routinely for lower limb arthroplasty, with smaller proportions giving TXA for spinal surgery (40%) and other major orthopaedic surgery (28%). Almost half (49%) give TXA routinely for major trauma surgery. Thirty-six percent indicated that they did not give TXA for major vascular, abdominal, pelvic or thoracic surgery. The majority administered TXA as a single, fixed dose. Fifty-seven percent agreed that there is uncertainty about the relative risks and benefits of perioperative TXA in noncardiac surgery and 87% agreed that large definitive trials determining the safety and efficacy of perioperative TXA in noncardiac surgery are required. These results indicate that for ANZCA Fellows the use of TXA in noncardiac surgery is highly variable, that there is uncertainty about the safety and efficacy of TXA, and that a large trial would be acceptable.

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Intravenous Tranexamic Acid and Lower Limb Arthroplasty—A Randomised Controlled Feasibility Study

Cited by 13 publications

References 22 publications

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Tranexamic acid does not affect intraoperative blood loss or in-hospital outcomes after acetabular fracture surgery

Tranexamic Acid Alters The Immunophenotype of Phagocytes After Lower Limb Surgery

A survey of anaesthetists’ use of tranexamic acid in noncardiac surgery

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