Reducing blood loss in simultaneous bilateral total knee arthroplasty: Combined intravenous–intra-articular tranexamic acid administration. A prospective randomized controlled trial

Karaaslan, Fatih; Karaoğlu, Sinan; Mermerkaya, Musa Uğur; Baktır, Ali

doi:10.1016/j.knee.2014.12.002

Cited by 53 publications

(76 citation statements)

References 49 publications

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“…Moreover, Zhu 10 also showed that the less drain volume existed, the less Hb decreased, and the less the need of transfusion in group with tranexamic acid compared to the control group. 7 This result clearly implied the rule of tranexamic acid as anti-bleeding. Fibrinolisis was avoided because tranexamic acid competitively blocked the lisin receptor in plasminogen.…”

Section: Discussionmentioning

confidence: 80%

“…However, in orthopedic field, the usage of the tranexamic acid is still debatable due to its benefit and risk balance. 7,8 Some research have suggested a beneficial usage for this medicine. Research that was done by Chen et al 9 implied that intraarticular tranexamic acid could lessen blood loss in TKR without increasing the surgery duration significantly.…”

Section: Discussionmentioning

confidence: 99%

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The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

Triyudanto

Lubis

2017

Med J Indones

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

Triyudanto

Lubis

2017

Med J Indones

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“…This process yielded 15 reports for full-text review. Of these, ten RCTs 9-18 fulfilled the inclusion criteria and were available for this meta-analysis. No additional publications were identified from manually searching the reference lists of retrieved studies and relevant reviews.…”

Section: Resultsmentioning

confidence: 99%

“…Sample sizes of individual RCTs ranged from 70 to 146 patients. Seven studies 9,10,12-15,17 compared the combination group with the placebo group, and six studies 9,11,13,14,16,18 compared the combination group with the single-dose group. Eight studies used the medial parapatellar approach, one 16 used minimally invasive subvastus and the remaining study 13 did not report the surgical approach.…”

Section: Resultsmentioning

confidence: 99%

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The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty

Yuan

Yin

et al. 2016

Bone & Joint Research

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ObjectivesTranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA.Materials and MethodsA systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.ResultsA total of ten RCTs (1143 patients) were included in this study. All the included studies were randomised and the quality of included studies still needed improvement. The results indicated that, compared with either placebo or the single-dose TXA (IV or IA) group, the combination of IV and IA TXA group had significantly less total blood loss, hidden blood loss, total drain output, a lower transfusion rate and a lower drop in haemoglobin level. There were no statistically significant differences in complications such as wound infection and deep vein thrombosis between the combination group and the placebo or single-dose TXA group.ConclusionsCompared with placebo or the single-dose TXA, the combined use of IV and IA TXA provided significantly better results with respect to all outcomes related to post-operative blood loss without increasing the risk of thromboembolic complications in TKA.Cite this article: Z. F. Yuan, H. Yin, W. P. Ma, D. L. Xing. The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty: combined tranexamic acid for TKA. Bone Joint Res 2016;5:353–361. DOI: 10.1302/2046-3758.58.BJR-2016-0001.R2.

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Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

Gibbs,

Champaneria,

Sandercock

et al. 2024

Cochrane Database of Systematic Reviews

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Background Hip and knee replacement surgery is a well‐established means of improving quality of life, but is associated with a significant risk of bleeding. One‐third of people are estimated to be anaemic before hip or knee replacement surgery; coupled with the blood lost during surgery, up to 90% of individuals are anaemic postoperatively. As a result, people undergoing orthopaedic surgery receive 3.9% of all packed red blood cell transfusions in the UK. Bleeding and the need for allogeneic blood transfusions has been shown to increase the risk of surgical site infection and mortality, and is associated with an increased duration of hospital stay and costs associated with surgery. Reducing blood loss during surgery may reduce the risk of allogeneic blood transfusion, reduce costs and improve outcomes following surgery. Several pharmacological interventions are available and currently employed as part of routine clinical care. Objectives To determine the relative efficacy of pharmacological interventions for preventing blood loss in elective primary or revision hip or knee replacement, and to identify optimal administration of interventions regarding timing, dose and route, using network meta‐analysis (NMA) methodology. Search methods We searched the following databases for randomised controlled trials (RCTs) and systematic reviews, from inception to 18 October 2022: CENTRAL (the Cochrane Library), MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO host ), Transfusion Evidence Library (Evidentia), ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP). Selection criteria We included RCTs of people undergoing elective hip or knee surgery only. We excluded non‐elective or emergency procedures, and studies published since 2010 that had not been prospectively registered (Cochrane Injuries policy). There were no restrictions on gender, ethnicity or age (adults only). We excluded studies that used standard of care as the comparator. Eligible interventions included: antifibrinolytics (tranexamic acid (TXA), aprotinin, epsilon‐aminocaproic acid (EACA)), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants and non‐fibrin sealants. Data collection and analysis We performed the review according to standard Cochrane methodology. Two authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using CINeMA. We presented direct (pairwise) results using RevMan Web and performed the NMA using BUGSnet. We were interested in the following primary outcomes: need for allogenic blood transfusion (up to 30 days) and all‐cause mortality (deaths occurring up to 30 days after the operation), and the following secondary outcomes: mean number of transfusion episodes per person (up to 30 days), re‐operation due to...

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Reducing blood loss in simultaneous bilateral total knee arthroplasty: Combined intravenous–intra-articular tranexamic acid administration. A prospective randomized controlled trial

Cited by 53 publications

References 49 publications

The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

The effects of intra-articular tranexamic acid given intraoperatively and intravenous tranexamic acid given preoperatively on post surgical bleeding and transfusion rate post total knee arthroplasty

The combined effect of administration of intravenous and topical tranexamic acid on blood loss and transfusion rate in total knee arthroplasty

Pharmacological interventions for the prevention of bleeding in people undergoing elective hip or knee surgery: a systematic review and network meta-analysis

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