The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients

Cai, Johnny; Ribkoff, Jessica; Olson, Sven R.; Raghunathan, Vikram; Al‐Samkari, Hanny; DeLoughery, Thomas G.; Shatzel, Joseph J.

doi:10.1111/ejh.13348

“…Tranexamic acid (TXA) is a traditional anti brinolytic drug that binds to lysine and forms a reversible complex with plasminogen and plasmin; it is an effective agent against plasmin, tissue plasminogen activators, and plasminogen 5 . Several studies reported that TXA could effectively reduce the perioperative RBC transfusion, blood loss, and blood drainage, and did not increase the risk of DVT formation; in addition, it has been shown to be cost-effective [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

¹

,

Lu

²

,

Wang

³

et al. 2020

Preprint

0

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Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedics. However, no study has investigated TXA in complex tibial plate surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of IV (intravenous) TXA and topical TXA. Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the IV group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution before 5 min prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared for the three groups.The pain functional and quality of life (QoL) assessment based on their corresponding scoring system. Results Baseline data were comparable for all groups. The IV group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 29.4 ml, 219.3 ± 33.4 ml, respectively, all p values < 0.001). The topical group performed excellently with regard to postoperative vascular events, wound complications, and adverse reactions, but there was no statistical significant in the incidence of these between the groups.In addition, the topical group benefited in reducing postoperative pain and better QoL. Conclusion This study presents the first information to show that both IV TXA and topical TXA are safe and effective for complex tibial plateau fractures. The IV regimen effectively reduced blood loss during the perioperative period, whereas the topical regimen had a better safety profile and QoL.

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“…Several studies have reported that TXA can effectively reduce the rate of perioperative blood transfusion, blood loss, and drainage volume without increasing the risk of deep vein thrombosis (DVT) formation in trauma orthopedics. In addition, it has been shown to be costeffective [10][11][12][13][14] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

¹

,

Lu

²

,

Wang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 minutes prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P＜0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P＜0.05), 2.8 vs 3.3 (POD4, P＜0.05), and 2.1 vs. 2.6 (PO6W, P＜0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.Conclusion To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.

show abstract

“…Several studies have reported that TXA can effectively reduce the rate of perioperative blood transfusion, blood loss, and drainage volume without increasing the risk of deep vein thrombosis (DVT) formation in trauma orthopedics. [10][11][12][13][14] . In addition, it has been shown to be cost-effective.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Wang

¹

,

Lu

²

,

Wang

³

et al. 2020

Preprint

0

View full text Add to dashboard Cite

Background Previous studies have demonstrated the effectiveness and safety of tranexamic acid (TXA) in orthopedic surgery. However, no study has investigated TXA in complex tibial plateau fracture surgery. Therefore, the purpose of this study was to confirm the safety and effectiveness of i.v. (intravenous) TXA and topical TXA.Material and methods This was a retrospective analysis of prospectively collected data. The control group received an equal amount of placebo (physiological saline solution); the i.v. group received 1.0 g TXA by intravenous injection before the tourniquet was inflated and before the surgical incision was closed, and the topical group received 3.0 g TXA in 75 mL of physiological saline solution 5 minutes prior to the final tourniquet release. Perioperative blood loss, vascular events, wound complications, and adverse reactions were compared among the three groups. The pain, knee function, and quality of life (QoL) assessments were based on their corresponding scoring systems.Results Baseline data were comparable for all groups. The i.v. group showed the best results for total blood loss (TBL) and hidden blood loss (HBL) (424.5 ± 49.4 mL and 219.3 ± 33.4 mL, respectively, all P values < 0.001). Patients in the i.v. group had lesser real Hb decrease than those in the control group (0.9 vs 1.5, P＜0.001) and topical group (0.9 vs 1.2, P = 0.026). The blood coagulation level as measured using fibrinolysis (D-dimer) was lower in the i.v. group than in the control and topical groups on POD1 and POD3; however, this difference was not significant; the fibrin-degradation products also showed a similar trend. Patients in the topical group experienced less pain than those in the control group on POD2, POD4, and PO6W. The VAS pain score was 3.6 vs. 4.4 (POD2, P＜0.05), 2.8 vs 3.3 (POD4, P＜0.05), and 2.1 vs. 2.6 (PO6W, P＜0.001) in the topical group vs control group, respectively. No significant differences were identified in vascular events, wound complications, adverse reactions, knee function, and QoL among the three groups.Conclusion To our knowledge, this is the first study that showed both i.v. TXA and topical TXA are safe and effective for complex tibial plateau fractures. The i.v. regimen effectively reduced blood loss during the perioperative period, whereas patients under the topical regimen had less vascular events, wound complications, and a lower incidence of adverse reactions compared to those in the i.v. group.

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The many roles of tranexamic acid: An overview of the clinical indications for TXA in medical and surgical patients

Cited by 126 publications

References 69 publications

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: a retrospective study

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