Relative efficacy of tranexamic acid and preoperative anemia treatment for reducing transfusions in total joint arthroplasty

Styron, Joseph F.; Klika, Alison K.; Szubski, Caleb R.; Tolich, Deborah; Barsoum, Wael K.

doi:10.1111/trf.13955

Cited by 16 publications

(15 citation statements)

References 40 publications

(54 reference statements)

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“…Numerous investigators have demonstrated that TXA reduces transfusion in TJA . The questions that persist surrounding TXA are not so much whether it works but rather in whom to use it .…”

Section: Discussionmentioning

confidence: 99%

A rationale for universal tranexamic acid in major joint arthroplasty: overall efficacy and impact of risk factors for transfusion

et al. 2018

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BACKGROUND Tranexamic acid (TXA) therapy is effective in reducing postoperative red blood cell (RBC) transfusion in total joint arthroplasty (TJA), yet uncertainty persists regarding comparative efficacy and safety among specific patient subgroups. We assessed the impact of a universal TXA protocol on RBC transfusion, postoperative hemoglobin (Hb), and adverse outcomes to determine whether TXA is safe and effective in TJA, both overall and in clinically relevant subgroups. STUDY DESIGN AND METHODS A retrospective observational study was performed on patients undergoing TJA at our institution spanning 1 year before and after the implementation of a universal protocol to administer intravenous (IV) TXA. The primary outcome was percentage of patients transfused, and secondary outcomes were perioperative Hb and occurrence of adverse events (death, myocardial infarction, stroke, seizure, pulmonary embolism, deep vein thrombosis, and acute kidney injury ). Outcomes were compared in pre‐ and post‐protocol groups with χ2 analysis. Logistic regression compared risk of transfusion in pre‐ and post‐protocol subgroups of patients with differing risk for transfusion (anemia, body mass index [BMI], and sex). RESULTS No differences were found in baseline patient characteristics across pre‐ and post‐protocol groups (n = 1084 and 912, respectively). TXA use increased from 32.3% to 92.2% while transfusion rates decreased from 10.3% to 4.8% (p < 0.001). Postoperative Day 3 Hb increased from 95.8 to 101.4 g/L (p < 0.001). Logistic regression demonstrated reduced transfusion in post‐protocol subgroups regardless of sex, anemia, or BMI (p < 0.001). No increase in adverse events was observed (p = 0.8451). CONCLUSIONS Universal TXA was associated with a reduction of RBC transfusion, overall and in clinically relevant subgroups, strengthening the rationale for universal therapy.

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“…Numerous investigators have demonstrated that TXA reduces transfusion in TJA . The questions that persist surrounding TXA are not so much whether it works but rather in whom to use it .…”

Section: Discussionmentioning

confidence: 99%

A rationale for universal tranexamic acid in major joint arthroplasty: overall efficacy and impact of risk factors for transfusion

et al. 2018

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“…In relation to the transfusion requests related specifically to surgical procedures (an important focus of PBM projects), we chose, as a pilot, the orthopaedic specialty to verify: adequacy of the number of RBC requested for each surgery, percentage of patients submitted to surgery previously presenting with anaemia and the relation of the presurgical haemoglobin levels with the need for intra‐ and postoperative transfusion. This specialty was chosen following the trend of what was done in other PBM programmes in other continents , and considering the fact that this specialty does not generally have patients that require specific transfusion triggers or that require large volume transfusions (as in the case of cardiac surgeries), which facilitates their evaluation.…”

Section: Resultsmentioning

confidence: 99%

Implementing a patient blood management programme in Brazil: challenges and implications for developing countries

Benites

Addas‐Carvalho

2018

ISBT Science Series

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Background Patient blood management (PBM) programmes have the intention of promoting the rational use of blood, relying on up‐to‐date medical‐scientific evidence in a multidisciplinary approach, where the patient is the main focus of transfusion decisions. These programmes not only increase patient safety levels, but they also have the potential of lowering hospital costs. The aim of this study was to describe the implementation of a PBM programme at a University hospital in Brazil. Study design and methods The discussions regarding this PBM project were initially undertaken among the managers of the hospital's Transfusion Unit. Audits of transfusion practices were carried out, and these indices were presented in meetings with the Transfusion Committee and with other important stakeholders, in order for this information to support the delineation of the programme's work fronts. Results The project was promptly approved by the hospital's Board of Directors due to the relevance of the proposal, which required few financial resources as the project is mainly based on reorganization of workflows. The measures implemented included the following: didactic sessions aimed at the hospital staff, reformulation of the computerized system for the prescription of blood components, elaboration of a protocol for the use of antifibrinolytic drugs during the perioperative period and the institution of an outpatient clinic for evaluation of preoperative anaemia. Conclusion The benefits and challenges of a PBM project in a country with limited resources are analysed, discussing specificities in the scope of Brazilian Transfusion Medicine in a pioneering way.

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“…Many studies have been published on the use of TXA in total joint arthroplasty, and have produced positive clinical results. A retrospective cohort study involved 872 416 patients who had total hip or knee arthroplasty in 510 US hospitals by 2006–2012, and the results demonstrated that patients receiving TXA ( vs those who did not) showed lower rates of allogeneic or autologous transfusion (7.7% vs 20.1%), while not having increased risk of thromboembolic complications (0.6% vs 0.8%).…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon may be explained as follows. First, although TXA may have the potential risk of triggering thrombosis, this has not been confirmed. Some authors even suggest that TXA can reduce the risk of thrombosis by reducing the need for blood transfusions.…”

Section: Discussionmentioning

confidence: 99%

“…Tranexamic acid (TXA), a fibrinolytic inhibitor, can effectively and safely reduce perioperative blood loss and transfusion requirements in patients with primary TKA, although the optimal dosage and method of application is still controversial [6][7][8][9][10][11] . As a new strategy for reducing blood loss, adrenaline has also been used recently to reduce perioperative blood loss.…”

Section: Introductionmentioning

confidence: 99%

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Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

Zeng

et al. 2018

Orthopaedic Surgery

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The present study assessed the effectiveness of the combined administration of tranexamic acid (TXA) plus low‐dose epinephrine in primary total knee arthroplasty (TKA). We searched the following Chinese electronic databases: China National Knowledge Infrastructure and WanFang Data. We also searched the following English electronic databases: PubMed, Embase, Web of Science, and Central Register of Controlled Trials. To search for additional eligible studies, we also used Google's search engine. All randomized controlled trials (RCT) comparing TXA plus low‐dose epinephrine (Combined group) and TXA alone in TKA were systematically searched. The primary outcomes were total blood loss, hidden blood loss, the requirement for transfusion, maximum hemoglobin (Hb) drop, and deep venous thrombosis (DVT). Drainage volume, operation time, length of stay, hospital for special surgery (HSS) score, and range of motion (ROM) were considered as secondary outcomes. Subgroup analyses were performed to assess the benefits of using a tourniquet and the application routes of topical or intravenous TXA between the two groups. Statistical analysis was assessed using RevMan 5.3 software. Four independent RCT were included involving 426 patients, with 213 patients in the Combined group and 213 patients in the TXA alone group. In the Combined group there was significant reduction in total blood loss (MD, 204.70; 95% CI, −302.76 to −106.63; P < 0.0001), hidden blood loss (MD, 185.63; 95% CI, −227.56 to −143.71; P < 0.00001), drainage volume (MD, 93.49; 95% CI, −117.24 to −69.74; P < 0.00001), and maximum Hb drop (MD, 5.33, 95% CI, −6.75 to −3.91; P < 0.00001). No statistical differences were found postoperatively in terms of the requirement for transfusion (risk ratio, 0.52; 95% CI, 0.26–1.04; P = 0.06), operation time (MD, 0.85; 95% CI, −2.62 to 4.31; P = 0.63), length of stay (MD, −0.02; 95% CI, −0.52 to 0.47; P = 0.93), HSS score (MD, 0.78; 95% CI, −0.36 to 1.92; P = 0.18), and ROM (MD, 1.40; 95% CI, −1.01 to 3.81; P = 0.26), and not increasing the risk of DVT (risk ratio, 1.00; 95% CI, 0.33 to 3.02; P = 1.00) in the two groups. This meta‐analysis demonstrated that the administration of tranexamic acid plus low‐dose epinephrine is a safe and efficacious treatment to reduce total blood loss, hidden blood loss, drainage volume, and maximum Hb drop in primary TKA, without increasing the risk of DVT in primary THA.

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Relative efficacy of tranexamic acid and preoperative anemia treatment for reducing transfusions in total joint arthroplasty

Cited by 16 publications

References 40 publications

A rationale for universal tranexamic acid in major joint arthroplasty: overall efficacy and impact of risk factors for transfusion

A rationale for universal tranexamic acid in major joint arthroplasty: overall efficacy and impact of risk factors for transfusion

Implementing a patient blood management programme in Brazil: challenges and implications for developing countries

Tranexamic Acid Plus Low‐dose Epinephrine Reduces Blood Loss in Total Knee Arthroplasty: A Systematic Review and Meta‐analysis

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