OBTAIN E: outcome benefits of tranexamic acid in hip arthroplasty with enoxaparin: a randomised double-blinded controlled trial

Fraval, Andrew; Duncan, Sam; Murray, Theresa; Duggan, J; Tirosh, Oren; Tran, Phong

doi:10.1177/1120700018780125

Cited by 11 publications

(9 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1 ). Of these 43 RCTs [ 33 – 75 ], 17 RCTs [ 33 – 36 , 39 , 43 – 45 , 47 , 50 , 53 , 55 , 58 , 63 – 66 ] with a total of 804 patients reported THA using a TT and 26 RCTs [ 37 , 38 , 40 – 42 , 46 , 48 , 49 , 51 , 52 , 54 , 56 , 57 , 59 – 62 , 67 – 75 ] with a total of 1,454 patients reported THA using a standard operating table. Further information on the RCTs included [ 33 – 75 ] and patient characteristics are shown in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

Ramadanov,

Voss,

Hable

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

Background It remains unclear whether the use of an orthopaedic traction table (TT) in direct anterior approach (DAA) total hip arthroplasty (THA) results in better outcomes. The aim of this systematic review and network meta-analysis was to compare the THA outcomes through DAA on a standard operating table and the THA outcomes through DAA on a TT. Methods PubMed, Epistemonikos, and Google Scholar were searched for relevant randomized controlled trials (RCTs) up to 01 January 2024. An indirect comparison in network meta-analysis was performed to assess treatment effects between DAA on a TT and DAA on a standard table, using fixed-effects and random-effects models estimated with frequentist approach and consistency assumption. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were estimated for continuous variables and odds ratios (ORs) with 95% CIs were estimated for binary variables. Results The systematic review of the literature identified 43 RCTs with a total of 2,258 patients. DAA with TT had a 102.3 mL higher intraoperative blood loss and a 0.6 mmol/L lower Hb 3 days postoperatively compared with DAA without TT (SMD = 102.33, 95% CI 47.62 to 157.04; SMD = − 0.60, 95% CI − 1.19 to − 0.00). DAA with TT had a 0.15 lower periprosthetic fracture OR compared with DAA without TT (OR 0.15, 95% CI 0.03 to 0.86). There were no further significant differences in surgical, radiological, functional outcomes and in complication rates. Conclusion Based on our findings and taking into account the limitations, we recommend that particular attention be paid to the risk of periprosthetic fracture in DAA on a standard operating table and blood loss in DAA with TT. Since numerous other surgical, radiological, functional outcome parameters and other complication rates studied showed no significant difference between DAA on a standard operating table and DAA with TT, no recommendation for a change in surgical technique seems justified. Level of evidence Level I evidence, because this is a systematic review and meta-analysis of randomized controlled trials.

show abstract

Section: Resultsmentioning

confidence: 99%

Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

Ramadanov,

Voss,

Hable

et al. 2024

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Currently, there is no consensus among scientists about the combined use of anticoagulants and hemostatics. Fraval et al (2019) reports of efficacy of combined hemostatic and anticoagulant prophylaxis in patients after hip arthroplasty. In the group that had received tranexamic acid and enoxaparin sodium, the volume of intraoperative and postoperative blood loss was less (0.51 L and 1.13 L, respectively) than in the group that had received saline and enoxaparin sodium (0.698 L and 1.48 L, respectively) (p<0.001).…”

Section: Introductionmentioning

confidence: 99%

“…In the group that had received tranexamic acid and enoxaparin sodium, the volume of intraoperative and postoperative blood loss was less (0.51 L and 1.13 L, respectively) than in the group that had received saline and enoxaparin sodium (0.698 L and 1.48 L, respectively) (p<0.001). However, that article does not contain information about postoperative complications, that is, it does not mention the safety of the drugs used (Fraval et al 2019). Hourlier and Fennema (2018) studied the complications of combined use of hemostatic and anticoagulant drugs among patients with endoprosthetics.…”

Section: Introductionmentioning

confidence: 99%

Development of a risk-oriented algorithm for the combined use of hemostatics and anticoagulants to prevent thrombosis and bleeding cases after total arthroplasty of knee or hip joints

Головко¹,

Сафроненко²,

Gantsgorn³

et al. 2021

RRP

View full text Add to dashboard Cite

Introduction: The goal of our study was to develop a risk-oriented algorithm for the combined use of hemostatics and anticoagulants in patients after total arthroplasty of the knee or hip joints to reduce the risk of thrombohemorrhagic complications. Materials and methods: We performed a retrospective study (n=253). In group (Gr.) 1, the time interval (TI) between the administration of hemostatic and anticoagulant prophylaxis was ≤17 hours (n=145; 57.31%), and in Gr. 2 – 18-24 hours (n=108; 42.68%). We analyzed the influence of different factors on the development of thrombosis and bleeding cases after the operation. Results and discussion: Thrombohemorrhagic complications were observed in 27 (10.67%) patients. Thrombosis in Gr. 1 was associated with the use of tranexamic acid, and were recorded 2.2 times more often than in Gr. 2 (p<0.05). The development of thrombosis in Gr. 1 was influenced by: class II obesity, type 2 diabetes mellitus, myocardial infarction, venous pathology, age of patients >75 years, for women – an initially low level of international normalized ratio, and activated partial thromboplastin time (APTT) (p<0.05). The development of bleeding in Gr. 1 was influenced by: age >75 years, among men and women – an increased preoperative level of APTT, for women – a decreased level of fibrinogen and platelets (p<0.05). Conclusion: To prevent thrombosis and bleeding after arthroplasty of large joints, the TI between the use of hemostatics and anticoagulants should be at least 18 hours, especially in patients with the above risk factors, in particular, when using tranexamic acid and low molecular weight heparins.

show abstract

“…касается конкретных исследований, то, опираясь на полученные в них результаты, также нельзя сформулировать единых выводов. В частности, в одних работах рассматривается только эффективность применяемой профилактики, но не демонстрируется её безопасность [13]. Некоторые исследователи сообщают, что совместная профилактика не несёт в себе повышенных рисков развития тромбозов и кровотечений [14,15], однако в другом исследовании отмечается более высокая частота послеоперационных осложнений у пациентов, получавших транексамовую кислоту [16].…”

Section: Introductionunclassified

“…При анализе уровня влияния показателей гемостазиограммы до операции на развитие тромбозов в I гр. у женщин, было установлено, что исходно низкий уровень МНО ассоциировался с повышенным риском тромбозов в 13 Среди пациентов I гр. с развившимся тромбозом статистически значимые отличия были выявлены по таким показателям, как индекс массы тела -между пациентами с ожирением 2 степени и избыточной массой тела (p=0,037); возрастмежду пациентами молодого (18-43 лет) и среднего возраста (44-59 лет) (p=0,011), молодого и пожилого возраста (60-74 лет) (p=0,015), и пожилого и старческого возраста (75-90 лет) (p=0,029); ИМ в анамнезе (p=0,00002), СД 2 типа (p=0,00001) и патология вен (p=0,045), нарушение функции почек -между пациентами с незначительным и умеренным снижением почечной функции (p=0,046).…”

Section: Introductionunclassified

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

Головко¹,

Сафроненко²,

Gantsgorn³

2020

jour

View full text Add to dashboard Cite

Objective: to assess the effect of the baseline hemostasiogram and comorbid background on the development of thrombosis and bleeding in the early postoperative period in patients receiving combined hemostatic and anticoagulant pharmacoprophylaxis after arthroplasty of the knee and hip joints.Materials and Methods: A retrospective analysis of 253 case histories of patients with hip or knee arthroplasty performed. The patients received combined pharmacoprophylaxis with hemostatics and anticoagulants. Two groups were identified according to the time interval (TI) between the appointment of hemostatic and anticoagulant drugs. The first group (57,31%) - n=145 (112 women and 33 men), TI≤17 h, the second group (42,68%) — n=108 (78 women and 30 men), TI 18-24 h. In patients, we analyzed the effect of comorbidity and baseline values of the coagulogram on the risk of thrombosis or bleeding in the early postoperative period.Results: Thrombohemorrhagic complications were registered in 27 (10,67%) patients, of which 22 (81,48%) were in the first group. Thrombosis in the first group developed in the regimens with tranexamic acid (p=0,038), and their frequency was 2,2 times higher than in the second group (p=0,023). In the first group, the risk of thrombosis in women was increased by the initially low level of international normalized ratio (INR) (relative risk (RR)=13,333, p=0,00032) and activated partial thromboplastin time (APTT) (RR=5,8, p=0,037). The risk of bleeding in the first group among men and women increased with an increased preoperative APTT level (RR=18, p=0,0012 and RR=28, p=0,00022, respectively), and separately for women - with a reduced content of fibrinogen (RR=23,25, p=0,00065) and platelets (RR=10,2, p=0,038). The development of thrombosis as influenced by: degree 2 obesity (RR=8,75, p=0,037), type 2 diabetes mellitus (RR=21, p=0,00001), myocardial infarction (RR=16,875, p=0,00002), venous pathology (RR=8,1, p=0,045), moderate decline in renal function (RR=6,231, p=0,0465) and age over 75 years (RR=6,8, p=0,029). Age over 75 years increased the risk of bleeding 12-fold (RR=12, p=0,015).Conclusions: to minimize the risk of thrombosis and bleeding after endoprosthetics of large joints of the lower extremities, especially in patients with the above risk factors, in particular, when using tranexamic acid as a hemostatic, it is recommended to observe the TI between hemostatic and anticoagulant pharmacoprophylaxis of at least 18 hours.

show abstract

OBTAIN E: outcome benefits of tranexamic acid in hip arthroplasty with enoxaparin: a randomised double-blinded controlled trial

Abstract: ANZCTR number: ACTRN12616000606482.

Cited by 11 publications

References 14 publications

Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

Indirect comparisons of traction table versus standard table in total hip arthroplasty through direct anterior approach: a systematic review and frequentist network meta-analysis

Development of a risk-oriented algorithm for the combined use of hemostatics and anticoagulants to prevent thrombosis and bleeding cases after total arthroplasty of knee or hip joints

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

Contact Info

Product

Resources

About