Multiple Boluses of Intravenous Tranexamic Acid to Reduce Hidden Blood Loss After Primary Total Knee Arthroplasty Without Tourniquet: A Randomized Clinical Trial

Xie, Jinwei; Ma, Jun; Yao, Huan; Chen, Yue; Pei, Fuxing

doi:10.1016/j.arth.2016.04.034

Cited by 153 publications

(201 citation statements)

References 26 publications

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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%

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%

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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“…It was also reported that topical intra‐articular TXA can effectively reduce blood loss, joint swelling, and the need for blood transfusions after primary total knee arthroplasty . 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 .…”

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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“…The most efficacious regimen is still under debate, but multiple IV boluses regimens (pre/intra/post-operatively) prove to have a better result compared to a single IV dose[92]. Nevertheless, two RCTs concluded that intra-articular regimen of TXA is as effective as three doses IV regimen in preventing blood loss without any difference in thromboembolic complications[93,94].…”

Section: Intra-operativementioning

confidence: 99%

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

Themistoklis¹,

Vogiatzaki²,

Kazakos³

et al. 2017

WJO

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Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR.

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Multiple Boluses of Intravenous Tranexamic Acid to Reduce Hidden Blood Loss After Primary Total Knee Arthroplasty Without Tourniquet: A Randomized Clinical Trial

Cited by 153 publications

References 26 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

Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

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