One Intraoperative Dose of Tranexamic Acid for Patients Having Primary Hip or Knee Arthroplasty

Ralley, Fiona E.; Berta, Donna; Binns, Valerie; Howard, James L.; Naudie, Douglas D.R.

doi:10.1007/s11999-009-1217-8

Cited by 102 publications

(84 citation statements)

References 16 publications

(18 reference statements)

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“…One of the important findings in this study is that the intraarticular administration of TXA can effectively diminish the reduction of Hb levels by one week post-operation, and these results were consistent with other studies investigating the effect of intravenous administration of TXA in TKA patients [19,20,22]. As Ralley et al recently proposed that many of the dosing schedules reported were not ideally suited for routine application [22], this intra-articular administration of TXA, which was applied through the drain at the end of the operation, is simple, easy and suitable for clinical application.…”

Section: Discussionsupporting

confidence: 91%

“…While there have been many reports outlining single or repeated intravenous administration of TXA in TKA patients [19,20,22], the ideal method of providing TXA is still controversial [22]. It is generally accepted that only a small percentage of the intravenously injected drug reaches the target location, and it is thought that the mechanism of TXA action is inhibition of tissue fibrinolysis and consequent stabilisation of clots by TXA entering the extravascular space and accumulating in tissues for up to 17 hours [23].…”

Section: Introductionmentioning

confidence: 99%

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Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

Ishida

Tsumura

Kitagawa

et al. 2011

International Orthopaedics (SICOT)

210

192

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Purpose This is a randomised controlled trial to examine whether intra-articular injection of tranexamic acid (TXA) decreases blood loss, as well as reducing leg swelling after total knee arthroplasty (TKA). Methods We performed 100 TKA in osteoarthritis patients. At closure, a total of 2,000 mg/20 ml TXA was injected into the knee joint through a closed suction drain (TXA group). For the control group, the same volume of physiological saline was injected. The pre-operative condition of the patients, post-operative haemoglobin (Hb) levels, discharge volumes from drain, D-dimer and needs for transfusion were compared between these two groups. Furthermore, leg diameters (thigh, suprapatellar portion and calf girth) were measured pre-and post-operatively to investigate whether TXA has an influence on leg swelling after surgery. Results The results revealed that post-operative decrease in Hb level was significantly reduced in the TXA group. Furthermore, knee joint swelling after operation was significantly suppressed in the TXA group compared to the control group. Conclusions The results revealed intra-articular administration of TXA decreased not only blood loss, but also knee joint swelling after TKA.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

Ishida

Tsumura

Kitagawa

et al. 2011

International Orthopaedics (SICOT)

210

192

View full text Add to dashboard Cite

show abstract

“…Some authors recommended pre-operative blood donation [14], correction of preoperative anaemia [15], autologous donation and retransfusion systems [10,[16][17][18][19][20][21][22][23], supplementation of erythropoietin or iron [24,25], pharmacologic agents like tranexamic acid [26,27], plasmapheresis, normovolaemic haemodilution [28][29][30][31] and post-operative red blood cell salvage [32].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Hawi

Kendoff

Hessling

et al. 2014

International Orthopaedics (SICOT)

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Purpose The goal of this study was to analyse the efficacy of blood autotransfusion using a continuous autologous transfusion system in revisions of total hip arthroplasty (THA). We looked at whether administration of allogeneic blood units was reduced in these cases and if there is a difference between cemented and non-cemented revisions. Methods Between January 2011 and December 2011, patients being treated with revision THA were included (n=411). The following parameters were analysed: patient age, gender, weight (kg), height (cm), body mass index (BMI, kg/m 2 ), surgical diagnosis, treatment and American Society of Anesthesiologists (ASA) classification score. The difference between pre-and post-operative haemoglobin (Hb, g/dl), amount of peri-operative blood loss (ml), amount of retransfused washed shed blood and amount of allogeneic and/or autologous transfusion (ml) were recorded. Results In both the cemented and non-cemented revision THA groups, there was no significant difference between pre-and post-operative Hb with or without using an autotransfusion system. In 92 of 186 cemented cases using an autologous transfusion system (49.5 %) and 38 of 117 non-cemented cases using an autologous transfusion system (32.5 %), allogeneic blood transfusion (ABT) was required. Cemented procedures using an autologous transfusion system got significantly more ABTs than non-cemented procedures using an autologous transfusion system (p=0.0042, odds ratio=2.035).Conclusions Use of an autologous transfusion system did not reduce the amount of ABT in revision THA in the patient cohort reported here. In our opinion, general blood management is required before and during surgery to reduce administration of ABT.

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“…Recent observational studies have also shown an association between TXA use and reduced RBC transfusion. 12,13 Despite this clear affirmation of efficacy by numerous randomized trials, concerns about associated adverse outcomes and safety have not been adequately addressed largely due to the uniformly small sample size of these studies. This concern was cited as one of the main reasons for the strikingly low percent utilization of TXA (11.2%) in the United States.…”

Section: Résumémentioning

confidence: 99%

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

Baker

Pavenski

Pirani

et al. 2015

Can J Anesth/J Can Anesth

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One Intraoperative Dose of Tranexamic Acid for Patients Having Primary Hip or Knee Arthroplasty

Abstract: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 102 publications

References 16 publications

Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

Intra-articular injection of tranexamic acid reduces not only blood loss but also knee joint swelling after total knee arthroplasty

Effectiveness of an autologous transfusion system following cemented and non-cemented revisions of total hip arthroplasty

Universal tranexamic acid therapy to minimize transfusion for major joint arthroplasty: a retrospective analysis of protocol implementation

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