The effect of tranexamic acid on artificial joint materials: a biomechanical study (the bioTRANX study)

Alshryda, Sattar; Mason, James; Sarda, Praveen; Lou, Tengteng; Stanley, Martin; Wu, Junjie; Unsworth, A

doi:10.1007/s10195-014-0312-0

Cited by 13 publications

(5 citation statements)

References 22 publications

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“…Caution should exercised, however, when considering use in hemiarthroplasty, as recent research has identified a potential cytotoxic effect on chondrocytes in an animal model . There is, however, no suggestion of an adverse effect with artificial joint materials .…”

Section: Discussionmentioning

confidence: 98%

A systematic review of tranexamic acid in hip fracture surgery

Farrow

Smith

Ashcroft

et al. 2016

Brit J Clinical Pharma

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AIMTo systematically examine and quantify the efficacy and safety of tranexamic acid in hip fracture surgery. METHODSA systematic literature search was conducted using Medline, EMBASE, AMED, CiNAHL, and the Cochrane Central Registry of Controlled Trials. Two assessors independently screened search outputs for potentially relevant articles which met the eligibility criteria. The primary outcome measure was requirement of post-operative blood transfusion. Risk of bias assessment was performed using the Cochrane Collaboration's risk of bias tool for randomized controlled trials (RCTs) and the ROBINS-I tool for observational studies. Meta-analysis was performed to estimate risk ratio (RR), risk difference (RD) and mean difference (MD) values for dichotomous and continuous data outcomes, respectively. The interpretation of each outcome was made using the GRADE approach. RESULTSOf 102 studies identified, seven met the inclusion criteria including a total of 770 participants (TXA: 341; Control: 429). On metaanalysis, intravenous TXA resulted in a 46% risk reduction in blood transfusion requirement compared to a placebo/control group (RR: 0.54; 95% CI: 0.35-0.85; I 2 : 78%; Inconsistency (χ 2 ) P = <0.0001; n = 750). There was also a significantly higher postoperative haemoglobin for TXA versus placebo/control (MD: 0.81; 95% CI: 0.45-1.18; I 2 : 46%; Inconsistency (χ 2 ) P = 0.10; n = 638). There was no increased risk of thromboembolic events (RD: 0.01; 95% CI: À0.03, 0.05; I 2 : 68%; Inconsistency (χ 2 ) P = 0.007, n = 683). CONCLUSIONThere is moderate quality evidence that TXA reduces blood transfusion in hip fracture surgery, with low quality evidence suggesting no increased risk of thrombotic events. These findings are consistent with TXA use in other orthopaedic procedures.

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Section: Discussionmentioning

confidence: 98%

A systematic review of tranexamic acid in hip fracture surgery

Farrow

Smith

Ashcroft

et al. 2016

Brit J Clinical Pharma

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“…While these ramifications could significantly increase hospital stay, necessitate need for additional surgeries, and increase morbidity, there have been no reports to our knowledge of increased rates of PPI or DVT/PE in patients who are properly screened and given TXA. Additionally, Alshryda and Mason et al have just released results that show no biomechanical adverse effects on common TJA materials from topical TXA [9]. Fourth, the man-hour cost analysis was based on average salaries and what is perceived as minimum times it takes to accomplish tasks during blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Does Tranexamic Acid Reduce Blood Transfusion Cost for Primary Total Hip Arthroplasty? A Case–Control Study

Harris

Moskal

Capps³

2015

The Journal of Arthroplasty

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“…Topical TXA also has the potential to adversely affect implants, although this does not appear to be the case when assessed in an ex vivo setting. 20 It may be that a combination of IV and topical TXA could be of potential benefit. 21 …”

Section: Discussionmentioning

confidence: 99%

Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty

Morrison

Tsang

Fishley

et al. 2017

Bone & Joint Research

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ObjectivesWe have increased the dose of tranexamic acid (TXA) in our enhanced total joint recovery protocol at our institution from 15 mg/kg to 30 mg/kg (maximum 2.5 g) as a single, intravenous (IV) dose. We report the clinical effect of this dosage change.MethodsWe retrospectively compared two cohorts of consecutive patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery in our unit between 2008 and 2013. One group received IV TXA 15 mg/kg, maximum 1.2 g, and the other 30 mg/kg, maximum 2.5 g as a single pre-operative dose. The primary outcome for this study was the requirement for blood transfusion within 30 days of surgery. Secondary measures included length of hospital stay, critical care requirements, re-admission rate, medical complications and mortality rates.ResultsA total of 1914 THA and 2537 TKA procedures were evaluated. In THA, the higher dose of TXA was associated with a significant reduction in transfusion (p = 0.02, risk ratio (RR) 0.74, 95% confidence interval (CI) 0.58 to 0.96) and rate of re-admission (p < 0.001, RR 0.50, 95% CI 0.35 to 0.71). There were reductions in the requirement for critical care (p = 0.06, RR 0.55, 95% CI 0.31 to 1.00), and in the length of stay from 4.7 to 4.3 days (p = 0.02). In TKA, transfusion requirements (p = 0.049, RR 0.64, 95% CI 0.41 to 0.99), re-admission rate (p = 0.001, RR 0.56, 95% CI 0.39 to 0.80) and critical care requirements (p < 0.003, RR 0.34, 95% CI 0.16 to 0.72) were reduced with the higher dose. Mean length of stay reduced from 4.6 days to 3.6 days (p < 0.01). There was no difference in the incidence of deep vein thrombosis, pulmonary embolism, gastrointestinal bleed, myocardial infarction, stroke or death in THA and TKA between cohorts.ConclusionWe suggest that a single pre-operative dose of TXA, 30 mg/kg, maximum 2.5g, results in a lower transfusion requirement compared with a lower dose in patients undergoing elective primary hip and knee arthroplasty. However, these findings should be interpreted in the context of the retrospective non-randomised study design.Cite this article: R. J. M. Morrison, B. Tsang, W. Fishley, I. Harper, J. C. Joseph, M. R. Reed. Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty: The effectiveness of a single pre-operative dose. Bone Joint Res 2017;6:499–505. DOI: 10.1302/2046-3758.68.BJR-2017-0005.R1.

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The effect of tranexamic acid on artificial joint materials: a biomechanical study (the bioTRANX study)

Cited by 13 publications

References 22 publications

A systematic review of tranexamic acid in hip fracture surgery

A systematic review of tranexamic acid in hip fracture surgery

Does Tranexamic Acid Reduce Blood Transfusion Cost for Primary Total Hip Arthroplasty? A Case–Control Study

Dose optimisation of intravenous tranexamic acid for elective hip and knee arthroplasty

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