Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial

Pinsornsak, Piya; Rojanavijitkul, S; Chumchuen, Sukanis

doi:10.1186/s12891-016-1176-7

Cited by 46 publications

(58 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[11] TXA can be administrated by several routes including topical, intravenous, oral, and intramuscular. [12] TXA can take about 2 hours for oral, 30 minutes for intramuscular, and 5 to 15 minutes for intravenous to achieve the maximum plasma concentration. [13,14] Thus, the best suitable method for rapidly increasing the therapeutic concentration of TXA is by the intravenous route.…”

Section: Methodsmentioning

confidence: 99%

Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty

Lin

et al. 2016

Medicine

View full text Add to dashboard Cite

Background:The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to evaluate the efficacy and safety of combined topical with intravenous tranexamic acid (TXA) versus topical, intravenous TXA alone or control for reducing blood loss after a total knee arthroplasty (TKA).Methods:In May 2016, a systematic computer-based search was conducted in the PubMed, Embase, Cochrane Library, Web of Science, and Chinese Wanfang database. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement criteria. Only patients prepared for primary TKA that administration combined topical with intravenous TXA with topical TXA, intravenous (IV) TXA, or control group for reducing blood loss were included. Eligible criteria were published RCTs about combined topical with intravenous TXA with topical alone or intravenous alone. The primary endpoint was the total blood loss and need for transfusion. The complications of deep venous thrombosis (DVT) were also compiled to assess the safety of combined topical TXA with intravenous TXA. Relative risks (RRs) with 95% CIs were estimated for dichotomous outcomes, and mean differences (MDs) with 95% CIs for continuous outcomes. The Cochrane risk of bias tool was used to appraise a risk of bias. Stata 12.0 software was used for meta-analysis.Results:Fifteen studies involving 1495 patients met the inclusion criteria. The pooled meta-analysis indicated that combined topical TXA with intravenous TXA can reduce the total blood loss compared with placebo with a mean of 458.66 mL and the difference is statistically significant (MD = −458.66, 95% CI: −655.40 to 261.91, P < 0.001). Compared with intravenous TXA, combined administrated TXA can decrease the total blood loss, and the difference is statistically significant (MD = −554.03, 95% CI: −1066.21 to −41.85, P = 0.034). Compared with the topical administration TXA, the pooled meta-analysis indicated that combined TXA can decrease the amount of total blood loss with mean 107.65 mL with statistically significant(MD = −107.65, 95% CI: −525.55 to −239.9141.85, P = 0.001). The pooled results indicated that combined topical with intravenous TXA can decrease the need for transfusion (RR = 0.34, 95% CI: 0.23–0.50, P < 0.001). There is no significant difference between combined topical with intravenous TXA with topical or intravenous TXA (P > 0.05) in terms of need for transfusion and the occurrence of DVT.Conclusion:Compared with topical, intravenous TXA alone or control group, combined topical with TXA, can decrease the total blood loss and subsequent need for transfusion without increasing the occurrence of DVT. The dose and timing to administration TXA is different, and more randomized controlled trials are warranted to clarify the optimal dosing and time to administration TXA.

show abstract

Section: Methodsmentioning

confidence: 99%

Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty

Lin

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…previously cement was placed between the bone-cutting site and implant component to reduce bone oozing, and IAI of TXA was employed to reduce blood oozing after synovectomy. However, muscle oozing was not effectively managed using this approach, and the studies on IMI of TXA in unilateral TKA are limited [13][14][15]. Mao et al.…”

Section: Discussionmentioning

confidence: 99%

“…demonstrated that IMI and IAI of TXA e ciently at reducing blood loss during TKA compared with a control group; but the difference between IMI and IAI was nonsigni cant [13]. Pinsornsak et al reported that the antibleeding effects of intramuscular injected and intravenous injected TXA were similar [14]. Yozawa et al reported that compared with placebo treatment, IMI of TXA was e cient at decreasing blood loss and drops in Hb and hematocrit [15].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Significantly Reducing Blood Loss Using Intra-muscular Injection of Tranexamic Acid during Total Knee Arthroplasty

Lin¹,

Tsai²,

Wu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Administration of an intra-muscular injection (IMI) of tranexamic acid (TXA) had been demonstrated to be effective in reducing both blood loss and the transfusion rate during total knee arthroplasty (TKA). However, few studies have reported on the efficiency of IMI of TXA. We studied the efficiency of IMI of TXA to reduce blood loss during TKA. Methods In this prospective study, 50 patients undergoing primary simultaneous bilateral TKA were enrolled. The right knee received a IMI of 1 g of TXA (Group I), and the left knee received an intra-articular injection (IAI) of 1 g of TXA (Group II). The clinical outcome measures were a change in hemoglobin levels, blood loss from Hemovac, and number of allogeneic blood units. Results Compared with Group II, the decrease in blood loss from Hemovac was significantly less for Group I (460.1 ± 36.79 vs. 576.0 ± 34.01, P < 0.001), and no significant difference in surgical times was observed. Conclusions IMI of TXA can significantly reduce blood loss than IAI of TXA during TKA without increased complications such as surgical site infection, poor wound healing, skin necrosis, pulmonary embolism, and deep vein thrombosis.

show abstract

“…Standard dosing ranged from 0.5 to 3 g for IV TA. Patients received a single 13,16,19,20,[22][23][24]26,27,31,[33][34][35][36][37][38][39][40][41]43,45 , double 12,17,21,24,25,30,35,44 , or triple 7,14,15,18,28 dosing of TA, depending on the study. Finally, the timing of IV administration differed amongst the reports.…”

Section: Discussionmentioning

confidence: 99%

Comparison of weight-based versus standard dosing of tranexamic acid for blood loss and transfusion amount in knee arthroplasty without tourniquet

Güler

Çarkçı²,

Çerci³

et al. 2019

Preprint

View full text Add to dashboard Cite

Backgruond To compare weight-based versus standard dosing of intravenous (IV) tranexamic acid for blood loss and transfusion amount in total knee arthroplasty (TNA) without tourniquet. Methods A total of 99 patients who underwent TNA with the diagnosis of primary osteoarthritis were enrolled in this retrospective case-control study. Patients were divided into two groups according to the application of tranexamic acid. Group 1 (weight-based dosing): 10 mg/kg IV TA 30 min before the skin incision, and 10 mg/kg, at postoperative 30 min, and 3 h. Group 2 (standard dosing): 1 g of IV TA 30 min before skin incision, and 1 g at postoperative 30 min and 3 h. Hemoglobin levels, before, and 1, and 2 days after the operation, postoperative amount of decrease in hemoglobin levels, and amount of erythrocyte transfusion were recorded. Two scoring systems Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were applied in the evaluation of TNA results preoperatively, and at 1., 3., 6., and 12. months, postoperatively. Results Both groups did not differ from each other by means of age (p=0.127), gender (p=0.528), BMI (p=0.782), operating sides (p=0.544), existing comorbidities (p=0.987), preoperative hemoglobin level (p=0.718), the amount of hemoglobin reduction (p=0.769), and the amount of erythrocytes transfused (p=0.913). In both study groups, hemoglobin levels in male patients dropped significantly more deeply than female patients. Also, in both study groups, hemoglobin levels were significantly lower in patients with comorbid illnesses. A statistically significant difference was not detected between Groups 1 and 2 in terms of pre- and postoperative WOMAC scores, KSS knee scores, and KSS function scores. Conclusion Our study showed that weight-based and standard dosing of IV tranexamic acid treatments were similar in efficacy and safety. Both treatments reduce blood loss and the need for transfusion. Also, there was no significant difference in terms of reliability between the two groups.

show abstract

Peri-articular tranexamic acid injection in total knee arthroplasty: a randomized controlled trial

Cited by 46 publications

References 27 publications

Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty

Is combined topical with intravenous tranexamic acid superior than topical, intravenous tranexamic acid alone and control groups for blood loss controlling after total knee arthroplasty

Significantly Reducing Blood Loss Using Intra-muscular Injection of Tranexamic Acid during Total Knee Arthroplasty

Comparison of weight-based versus standard dosing of tranexamic acid for blood loss and transfusion amount in knee arthroplasty without tourniquet

Contact Info

Product

Resources

About