OBTAIN A: Outcome Benefits of Tranexamic Acid in Hip Arthroplasty. A Randomized Double-Blinded Controlled Trial

Fraval, Andrew; Effeney, Peter; Fiddelaers, Lena; Smith, B L; Towell, Ben; Tran, Phong

doi:10.1016/j.arth.2016.11.045

Cited by 36 publications

(41 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is likely due to a combination of improved surgical techniques, the use of pharmaceutical agents such as TXA and local vasoconstrictors, improved fluid management in the perioperative period, and changing transfusion thresholds. There has been extensive and compelling literature on TXA proving its efficacy of reducing blood loss and transfusion rates [9,[19][20][21][22][23]. Some institutions have implemented practice changes within the past few years, foregoing routine T&S in low-risk patients [8,11].…”

Section: Discussionmentioning

confidence: 99%

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

et al. 2020

View full text Add to dashboard Cite

Background: Despite decreasing transfusion rates, routine type and screens are frequently used before primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). The aims of this study were to characterize transfusion rates and identify any factors that affect the likelihood of transfusion to determine if it is safe to discontinue routine preoperative type and screens at an academic hospital. Methods: A retrospective chart review was performed for all patients who underwent primary THA or TKA in 2019 at an academic institution by a fellowship-trained arthroplasty surgeon. Data on preoperative type and screens, transfusion rates, bleeding disorders, and anticoagulation status were obtained. Patients were considered to have a preoperative type and screen if it was performed within 30 days before surgery. Results: Overall, 379 patients were included in the study. Of these, 210 underwent primary THA and 169 underwent primary TKA. Four patients received transfusions during their hospitalization for a cumulative transfusion rate of 1.06%. No patients received an intraoperative transfusion. One (0.59%) patient received a postoperative transfusion after TKA, and 3 (1.43%) patients received a postoperative transfusion after THA. The mean preoperative hemoglobin of the 4 transfused patients was 10.8 g/dL. Conclusions: In summary, performing a preoperative routine type and screen is likely unnecessary at academic medical centers. Consideration for obtaining a type and screen may include complex primary surgeries or when patients have preoperative hemoglobin of less than 11 g/dL. Ultimately, preoperative type and screen should be considered on a case-by-case basis using clinical judgment.

show abstract

Section: Discussionmentioning

confidence: 99%

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

et al. 2020

View full text Add to dashboard Cite

show abstract

“…The operation will be much more difficult because the identification and exposure of the femoral neck and acetabulum are always complicated [7]. To reduce blood loss, most surgeons pay close attention to the surgical technique and use tranexamic acid, but rarely care the feature of disease [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Jiang

Pan

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background: Total hip arthroplasty (THA) has been highlighted as the best treatment option for ankylosing spondylitis (AS) patients with advanced hip involvement. The huge blood loss associated with THA is a common concern of postoperative complications. Disease activity is a specific reflection of systematic inflammation of AS. The purpose of this study was to determine the effect of disease activity on blood loss during THA in patients with AS. Methods: Forty-nine patients with AS who underwent unilateral THAs were retrospectively studied. Ankylosing Spondylitis Disease Activity Score (ASDAS) was employed to evaluate the disease activity. Orthopedic Surgery Transfusion Hemoglobin European Overview (OSTHEO) formula was used to assess the surgical blood loss. The patients were divided into active group (ASDAS≥1.3; n = 32) and stable groups (ASDAS< 1.3; n = 17) based on the ASDAS. Peri-operative laboratory values, plain radiographs, intra-operative data, transfusion volume, and use of hemostatic agents were recorded and statistically analyzed. Results: The ASDAS, pre-operative C-reactive protein level, erythrocyte sedimentation rate, and fibrinogen concentration in the active group were higher than the stable group (all P < 0.05); however, the pre-operative hemoglobin concentration and albumin level were higher in the stable group (both P < 0.05). The total blood loss during THA in stable patients was 1415.31 mL and 2035.04 mL in active patients (P = 0.006). The difference between the two groups was shown to be consistent after excluding the gender difference (P = 0.030). A high transfusion rate existed in both groups (stable group, 76.47% with an average of 1.53 units; active group, 84.37% with an average of 2.31 units), but there was no significant difference between the two groups (both P > 0.05). Compensated blood loss, corresponding to transfusion, was noted significantly more in the active group compared to the stable group (P = 0.027). There was no significant difference with regard to functional recovery (P > 0.05). Conclusion: Active AS patients are at high risk for increased blood loss during THA compared to stable patients. The underlying mechanism includes disorders of the coagulation and fibrinolytic systems, poor nutrition status, osteoporosis, imbalance of oxidative-antioxidative status and local inflammatory reaction. It is strongly recommended to perform THA in AS patients with stable disease.

show abstract

“…Eighteen trials[ 17 – 21 , 23 , 24 , 27 , 29 – 32 , 35 – 38 , 40 , 41 ] involving a total of 1799 patients reported data for total blood loss. All interventions significantly reduced total blood loss compared with placebo; however, no difference was observed across the four non-placebo interventions ( Fig 3B ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 23 trials[ 17 – 23 , 25 , 27 – 41 ] with 1982 patients reported the data for DVT, and 18 trials[ 17 – 21 , 23 , 25 , 27 , 28 , 30 , 32 – 34 , 36 – 40 ] with 1776 patients reported data for PE. In this analysis, placebo was used as the reference.…”

Section: Resultsmentioning

confidence: 99%

Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

Yoon

Kim

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundTranexamic acid (TXA) has been demonstrated to minimize blood loss after total hip arthroplasty. There are three main routes: intravenous (IV), intra-articular (topical), and combined (IV and topical) but little consensus support which is most effective and safe. We performed network meta-analysis.to assess the comparative efficacy and safety of three different administration routes of TXA.MethodsTwenty-five randomized controlled trials (RCT) were evaluated. Interventions were classified as: combined, IV multiple, IV single, topical and placebo. The primary outcome was effectiveness (transfusion rate, total blood loss, and total drain out). The secondary outcome was safety, based on the incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE).ResultsA total of 2227 patients were included in the 5 categories: 564 IV single, 319 IV multiple, 398 topical, 120 combined, and 826 placebo. A network meta-analysis identified the most effective interventions in terms of reducing the need for transfusion as follows: combined = 98.2%, IV single = 54.0%, IV multiple = 78.6%, topical = 66.1%, placebo = 0.0%. Compared with placebo, the IV single, IV multiple, topical, and combined interventions showed no difference in the rate of occurrence of DVT and PE.ConclusionsA network meta-analysis indicated that combined administration of TXA (IV and topical) was effective in reducing the transfusion rate after hip arthroplasty compared with IV or topical alone. As no high-risk patients were evaluated in the RCTs, it is not known whether the combined method is safer for patients susceptible to DVT or PE.

show abstract

OBTAIN A: Outcome Benefits of Tranexamic Acid in Hip Arthroplasty. A Randomized Double-Blinded Controlled Trial

Cited by 36 publications

References 18 publications

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

Routine Type and Screens Are Unnecessary for Primary Total Hip and Knee Arthroplasties at an Academic Hospital

Active ankylosing spondylitis increases blood loss during total hip arthroplasty for a stiff hip joint

Optimal use of tranexamic acid for total hip arthroplasty: A network meta-analysis

Contact Info

Product

Resources

About