One Dose Versus Two Doses of Intravenous Tranexamic Acid in Total Joint Arthroplasty

Golz, Andrew; Yee, Heather; Davis, Benjamin J.; Adams, William; Brown, Nicholas

doi:10.5435/jaaos-d-20-00658

Cited by 5 publications

(9 citation statements)

References 34 publications

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“…The initial review yielded 1238 papers [(Pubmed ( n = 239), Embase ( n = 261), Web of Science ( n = 385), Cochrane Library ( n = 22), and Medline ( n = 331)] after removing duplicates, and a total of 580 papers were screened. A total of 510 studies were excluded at the title and abstract level, and 5 studies were finally included by reading the full text and nadir criteria [ 28 , 30 , 38 – 40 ]. A total of 5542 patients were included for data extraction and meta-analysis.…”

Section: Resultsmentioning

confidence: 99%

“…3 A). Sensitivity analysis was performed and found that after excluding the Charette 2019 and Golz 2021gramroups of trials [ 39 , 40 ], although the point estimates were in the same direction; the results of the remaining three groups still showed no difference between the two groups, but heterogeneity I 2 from 80 to 36% (RD = 0.00, 95% CI [− 0.01, 0.02], P = 0.32, Fig. 3 B).…”

Section: Resultsmentioning

confidence: 99%

“…Five articles [ 28 , 30 , 38 – 40 ] (5454 patients) reported the incidence of deep vein thrombosis. No significant heterogeneity was found ( P = 0.13; I 2 = 41%), so a fixed-effects model was used.…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis

et al. 2023

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Objective With the increasing prevalence of osteoarthritis of the hip and knee, total joint replacement, the end-stage treatment, provides pain relief and restoration of function, but is often associated with massive blood loss. Tranexamic acid (TXA) has been reported to reduce perioperative blood loss in hip or knee arthroplasty. However, the optimal dose of TXA administration remains controversial. Therefore, we performed a meta-analysis combining data from 5 trials comparing the efficacy and safety of one fixed dose of 1 g intravenously administered TXA with two doses of 1 g each administered intravenously for hip or knee arthroplasty. Methods PubMed, Medline, Embase, Web of Science, and The Cochrane Library were searched from January 2000 to February 2023. Our meta-analysis included randomized controlled trials and cohort studies comparing the efficacy and safety of different doses of intravenous TXA (IV-TXA) for THA or TKA. The observation endpoints included total blood loss, postoperative hemoglobin drop, blood transfusion rate, length of hospital stay, incidence of deep venous thrombosis (DVT), and incidence of pulmonary embolism (PE). Meta-analysis was performed according to Cochrane's guidelines and PRISMA statement. The Danish RevMan5.3 software was used for data merging. Results Five cohort studies involving 5542 patients met the inclusion criteria. Our meta-analysis showed that the two groups were significantly higher in total blood loss (mean difference (MD) = − 65.60, 95% confidence interval (CI) [− 131.46, 0.26], P = 0.05); blood transfusion rate (risk difference (RD) = 0.00, 95% CI [− 0.01, 0.02], P = 0.55); postoperative hemoglobin (MD = 0.02, 95% CI [− 0.09, 0.13], P = 0.31); postoperative hospital stay days (MD = − 0.13), 95% CI [− 0.35, 0.09], P = 0.25); DVT (RD = 0.00, 95% CI [− 0.00, 0.01], P = 0.67); PE (RD = 0.00, 95% CI [− 0.01, 0.00], P = 0.79). There was some inherent heterogeneity due to variance in sample size across each major study. Conclusion 1 dose of 1 g and 2 doses of 1 g IV-TXA each time have similar effects on reducing blood loss, blood transfusion rate, postoperative hemoglobin level, and postoperative hospital stay after TKA or THA, without increasing the risk of postoperative complications risk. For patients at high risk of thromboembolic events, one dose of 1 g TXA throughout surgery may be preferred. However, higher-quality RCT is needed to explore the optimal protocol dose to recommend the widespread use of TXA in total joint arthroplasty. Trial registration We conducted literature selection, eligibility criteria evaluation, data extraction and analysis on the research program registered in Prospero (CRD42023405387) on March 16, 2023.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis

et al. 2023

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“…Our approach involved a single adequately dosed shot to inhibit fibrinolysis during peak blood loss, without the need for repeated doses. Multiple trials have confirmed the efficacy of single-shot TXA compared to repeated-dose regimens [ 14 , 25 , 26 ]. The use of TXA plays a positive role in primary TKA, reducing the occurrence of hematomas [ 27 ], hidden blood loss, and the need for allogeneic blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

An observational study of an adjusted patient blood management protocol intended to lower rates of transfusion following total knee arthroplasty in patients with preoperative anemia

Hourlier,

Fennema

2023

J Orthop Surg Res

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Background Patients with preoperative anemia have a higher risk of requiring blood transfusion after major orthopedic surgery due to increased blood loss and closer transfusion thresholds. Various patient blood management (PBM) policies aim to reduce transfusion rates. This observational study aimed to investigate blood loss and evaluate the effectiveness of an adjusted surgical PBM protocol in patients with anemic chronic disease (ACD) undergoing elective total knee arthroplasty (TKA). Methods A consecutive cohort of patients underwent elective unilateral TKA with an adjusted PBM protocol. The protocol consisted of epoetin (EPO) alfa therapy prescribed by the surgeon, routine administration of tranexamic acid (TXA), and standardized postoperative pharmacologic prophylaxis for thromboembolism. The performance of this PBM protocol was analyzed in patients with a baseline hemoglobin level of less than 12 g/dl. Hemoglobin levels were controlled at admission, on postoperative day (POD) 1, and on POD 7 ± 1. A bleeding index (BI-7) was used as an estimate of blood loss up until POD 7. Multiple linear regression was used to assess whether there were any differences in BI-7 between ACD– and ACD + patients. Results A total of 751 patients with complete hemoglobin monitoring were included in the study. Of these patients, 68 (9.1%) had a baseline hemoglobin concentration of less than 12 g/dl (ACD group). In this group, 28 patients (41.2%) received preoperative EPO therapy. The mean adjusted BI-7 for the study population was 3.0 (95% CI, 2.9 to 3.0) g/dl in the ACD– group and 2.3 (95% CI, 2.0–2.6) g/dl in the ACD + group. The difference in BI-7 was statistically significant (difference, 0.6 [95% CI: 0.3 to 0.9] g/dl, p < 0.001). No major complications occurred in the ACD + group, whereas there were three complications in the ACD– group (p = 1.00). Conclusions ACD patients undergoing TKA did not have an increased risk of bleeding or bleeding complications with the use of the adjusted PBM protocol. None of ACD patients required transfusion. ACD patients undergoing TKA experienced significantly less blood loss than patients with no preoperative anemia with the use of the adjusted PBM. We now consider the use of EPO in ACD patients with no nutritional deficiencies undergoing TKA at a baseline hemoglobin level of 11 g/dl. However, this should be validated in larger cohorts with a higher prevalence of ACD patients.

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“…Depending on the specific case, dosing recommendations have ranged from administering TXA at a dose of 15 mg/kg of body weight 12 to administering a bolus ranging from 1 to 4 g of TXA 13,14 . Some studies have experimented with providing multiple doses of TXA but have generally found similar outcomes between single and multiple-dose groups 15 . Common contraindications include a known allergy to TXA, intracranial hemorrhage, renal dysfunction, and history of thrombosis 16,17 .…”

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confidence: 99%

The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery

et al. 2021

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One Dose Versus Two Doses of Intravenous Tranexamic Acid in Total Joint Arthroplasty

Cited by 5 publications

References 34 publications

Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis

Efficacy and safety of single- and double-dose intravenous tranexamic acid in hip and knee arthroplasty: a systematic review and meta-analysis

An observational study of an adjusted patient blood management protocol intended to lower rates of transfusion following total knee arthroplasty in patients with preoperative anemia

The Efficacy and Safety of Tranexamic Acid Treatment in Orthopaedic Trauma Surgery

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