Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial

Chen, Jerry; Chin, Pak Lin; Moo, Ing How; Pang, Hee Nee; Tay, Darren Keng Jin; Chia, Shi‐Lu; Lo, Ngai Nung; Yeo, Seng Jin

doi:10.1016/j.knee.2015.09.004

Cited by 70 publications

(66 citation statements)

References 30 publications

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“…Since there may also have been hidden losses as a result of hemolysis and tissue extravasation, which would not have shown on drain output, the true effect of tranexamic acid on blood loss was not clear20). A true estimate of total blood loss can be more appropriately made using a hemoglobin balance method2021). The calculated blood loss based on hemoglobin drop and body volume takes into consideration both the hidden and evident losses.…”

Section: Introductionmentioning

confidence: 99%

“…The calculated blood loss based on hemoglobin drop and body volume takes into consideration both the hidden and evident losses. The purpose of this study was to assess the effect of tranexamic acid on total blood losses including hidden and evident losses through hemoglobin balance method21). We hypothesized that tranexamic acid would decrease the total blood loss during TKA measured using a hemoglobin balance method21).…”

Section: Introductionmentioning

confidence: 99%

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Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

Seol

Seon

Lee

et al. 2016

Knee Surg Relat Res

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PurposeTotal knee arthroplasty (TKA) accompanies the risk of bleeding and need for transfusion. There are several methods to reduce postoperative blood loss and blood transfusion. One such method is using tranexamic acid during TKA. The purpose of this study was to confirm whether tranexamic acid reduces postoperative blood loss and blood transfusion after TKA.Materials and MethodsA total of 100 TKA patients were included in the study. The tranexamic acid group consisted of 50 patients who received an intravenous injection of tranexamic acid. The control included 50 patients who received a placebo injection. The amounts of drainage, postoperative hemoglobin, and transfusion were compared between the groups.ResultsThe mean amount of drainage was lower in the tranexamic acid group (580.6±355.0 mL) than the control group (886.0±375.5 mL). There was a reduction in the transfusion rate in the tranexamic acid group (48%) compared with the control group (64%). The hemoglobin level was higher in the tranexamic acid group than in the control group at 24 hours postoperatively. The mean units of transfusion were smaller in the tranexamic acid group (0.76 units) than in the control group (1.28 units).ConclusionsOur data suggest that intravenous injection of tranexamic acid decreases the total blood loss and transfusion after TKA.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

Seol

Seon

Lee

et al. 2016

Knee Surg Relat Res

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“…Since early postoperative bleeding is the result of shift in hemostatic mechanism toward fibrinolysis, the antifibrinolytic drugs such as TXA are very effective to control this bleeding. Literature confirms this point, and there is little controversy regarding the effectiveness of drug [9,11] .…”

Section: Discussionmentioning

confidence: 84%

“…Moreover, 15 minutes after IV application, TXA reaches similar levels in the synovial fluid as in plasma [12] . The strength of 10 mg/kg has been shown to be effective in producing antifibrinolytic effect in various studies [9,13,14] . Drains in most series have been removed at fixed point of time i.e.…”

Section: Discussionmentioning

confidence: 99%

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Result of tranexamic acid in controlling blood loss in total knee and hip replacement surgery

Saini¹,

Singh²,

Sinha³

2018

Int. J. Orthop. Sci.

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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Intravenous versus intra-articular tranexamic acid in total knee arthroplasty: A double-blinded randomised controlled noninferiority trial

Cited by 70 publications

References 30 publications

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

Result of tranexamic acid in controlling blood loss in total knee and hip replacement surgery

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

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