The Assessment of Blood Loss During Total Knee Arthroplasty When Comparing Intravenous vs Intracapsular Administration of Tranexamic Acid

May, Jedediah H.; Rieser, G. Ryan; Williams, Chad; Markert, Ronald J.; Bauman, Ryan D.; Lawless, Matthew W.

doi:10.1016/j.arth.2016.04.018

Cited by 41 publications

(37 citation statements)

References 36 publications

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“…Four trials 16,32,35,39 were found to have a low risk of bias and 11 trials 17,31,33,34,[36][37][38][40][41][42][43] were found to have a high risk of bias (►Fig. 2).…”

Section: Risk Of Biasmentioning

confidence: 99%

“…Adequate randomized sequence was generated in 14 trials, 16,17,[31][32][33][34][35][36][37][38][39][41][42][43] and appropriate allocation concealment was reported in 12 trials. 16,17,31,32,34,35,[37][38][39][41][42][43] Blinding of participants and outcome assessors was clear only in four trials. 16,32,35,39…”

Section: Risk Of Biasmentioning

confidence: 99%

“…A total of 15 trials 16,17,[31][32][33][34][35][36][37][38][39][40][41][42][43] provided direct comparison of topical and intravenous TXA on blood transfusion rate. The pooled analysis for transfusion rate showed no statistically significant difference in the topical group compared with the intravenous group (RD ¼ 0.00, 95% CI ¼ À 0.02 to 0.03, p ¼ 0.75, ►Fig.…”

Section: Blood Transfusion Ratementioning

confidence: 99%

See 2 more Smart Citations

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

et al. 2017

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The use of tranexamic acid (TXA) during primary total knee arthroplasty (TKA) is well documented. However, considering the potential side effects, including deep vein thrombosis (DVT) and pulmonary embolism (PE), the ideal route of administration remains controversial. Therefore, we performed a meta-analysis to compare the efficacy of topical versus intravenous TXA and explore the most effective regimen in patients undergoing primary TKA. We conducted a systematic literature search in PubMed, Embase, and the Cochrane database through July 2016 to identify randomized controlled trials (RCTs) evaluating the efficacy and safety of topical and intravenous TXA in primary TKA. We assessed the risk of bias using the Cochrane Collaboration's tool. We assessed the quality of evidence using the GRADE profiler software. A total of 15 RCTs including 1,240 participants met the inclusion criteria. We found no statistically significant difference between topical and intravenous TXA in terms of transfusion rate ( = 0.75), total blood loss ( = 0.51), total drain output ( = 0.60), maximum hemoglobin drop ( = 0.24), length of stay ( = 0.08), and thromboembolic complications ( = 0.73). Subgroup analyses showed that compared with 1 g topical TXA, 2 g topical TXA was more effective to reduce blood transfusion rate and total blood loss, and did not increase thromboembolic complications. We also found three times intravenous TXA was more effective than one time of intravenous TXA to reduce blood transfusion rate and total blood loss without increasing of thromboembolic complications. Topical TXA had a similar efficacy to intravenous TXA in reducing blood transfusion and blood loss, and did not increase the risk of thromboembolic complications in primary TKA. Besides, the current meta-analysis suggested that three times of intravenous TXA is efficient and safe. We also recommended 2 g topical TXA instead of 1 g topical TXA because it was more efficient to reduce blood transfusion rate and total blood loss and did not increase thromboembolic complications.

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“…Four trials 16,32,35,39 were found to have a low risk of bias and 11 trials 17,31,33,34,[36][37][38][40][41][42][43] were found to have a high risk of bias (►Fig. 2).…”

Section: Risk Of Biasmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

Section: Blood Transfusion Ratementioning

confidence: 99%

See 1 more Smart Citation

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

et al. 2017

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“…The daily transition of Hb drop and the estimated blood loss were investigated over an initial 24 h (from the beginning of TKA to 24 h after TKA), from 24 h to 48 h, and from 48 h to 72 h. The blood loss was calculated using the formula developed by Nadler et al; [13][14][15][16] the formula estimates blood volume by accounting for gender, weight, and size of the patient and calculates blood loss using the patient's blood volume and Hb reduction rate. If transfusion was performed, 0.7 g/dL per 1unit (320 mL of packed red blood cells) was added to the value of Hb drop.…”

Section: Methodsmentioning

confidence: 99%

Daily blood loss transition after total knee arthroplasty with topical administration of tranexamic acid: Paradoxical blood loss after action of tranexamic acid

Song

Lee

Bae³

et al. 2020

J Orthop Surg (Hong Kong)

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Purpose: The purpose of this study was to compare the daily blood loss transition between groups with and without topical administration of tranexamic acid (TXA) after cruciate retaining (CR) and posterior stabilized (PS) total knee arthroplasty (TKA). Methods: A total of 220 patients undergoing unilateral TKA were enrolled in CR and PS TKAs, which were divided into groups that received topical administration of TXA (TXA group) or without TXA (non-TXA group). Each group in both types of TKA included 55 patients. The daily transition of blood loss was compared between the TXA and the non-TXA groups in CR and PS TKAs. The blood loss was calculated through Nadler formula using the patient's blood volume and hemoglobin reduction rate. Results: Total blood loss was significantly lower in the TXA group in both CR and PS TKAs (p < 0.001, respectively). The blood loss was lower for 0-24 h and 24-48 h after TKA. However, from 48 h to 72 h, it was greater in the TXA group (253.1 vs. 34.6 mL; p < 0.001) in CR TKAs. These tendencies were similar in PS TKAs after 48 h (186.2 vs. 134.9 mL, p ¼ 0.223). Conclusions: Topical administration of TXA for reduction of blood loss seemed to be effective up to 48 h after both CR and PS TKAs. The blood loss after 48 h tended to be even greater in the TXA group. Future studies will be required to identify the pharmacokinetic evidence for this clinical finding. Level of evidence: Level II.

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“…In den letzten Jahrzehnten konnte die Anzahl der Komplikationen reduziert werden. Dazu haben neben der weitgehenden Standardisierung der Operation auch perioperative Maßnahmen wie die präoperative Antibiotikaprophylaxe oder die Anwendung von Tranexamsäure beigetragen [4]. Weitere Änderungen, die den Patientenkomfort steigern, ohne Einfluss auf die Komplikationsrate zu haben, sind ▪ das Operieren ohne Blutsperre, ▪ der Verzicht auf Drainagen, ▪ die intraartikuläre Analgesie über Pumpensysteme und ▪ die lokale Infiltrationsanästhesie (LIA) [5][6][7].…”

Section: Merkeunclassified

Primäre Endoprothetik am Kniegelenk

Matziolis¹,

Röhner²

2017

Orthopädie und Unfallchirurgie up2date

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The Assessment of Blood Loss During Total Knee Arthroplasty When Comparing Intravenous vs Intracapsular Administration of Tranexamic Acid

Cited by 41 publications

References 36 publications

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Most Effective Regimen of Tranexamic Acid for Reducing Bleeding and Transfusions in Primary Total Knee Arthroplasty: A Meta-Analysis of Randomized Controlled Trials

Daily blood loss transition after total knee arthroplasty with topical administration of tranexamic acid: Paradoxical blood loss after action of tranexamic acid

Primäre Endoprothetik am Kniegelenk

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