The safest and most efficacious route of tranexamic acid administration in total joint arthroplasty: A systematic review and network meta-analysis

Xu, Shaohua; Chen, Jerry; Zheng, Qishi; Lo, Ngai Nung; Chia, Shi‐Lu; Tay, Kae Sian; Pang, Hee Nee; Shi, Luming; Chan, Eng Soon; Yeo, Seng Jin

doi:10.1016/j.thromres.2019.02.006

Cited by 56 publications

(50 citation statements)

References 18 publications

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“…Poeran et al conducted a retrospective study of 872 416 patients with joint replacement and found that the use of TXA did not increase or even reduce the incidence of perioperative thrombotic events. A meta‐analysis of 211 related studies by Xu et al found that intravenous or topical TXA in total knee and total hip arthroplasty did not increase the risk of postoperative thrombosis. There are few reports on the application of TXA in HTO to the study of postoperative coagulation and venous thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case‐Control Study

Guo

et al. 2020

Orthopaedic Surgery

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Objective: To investigate whether intravenous combined with topical administration of tranexamic acid (TXA) is superior to intravenous administration alone in terms of blood loss, incision complications, functional recovery, and pain relief in high tibial osteotomy (HTO). Methods:Clinical data of patients with knee osteoarthritis (OA) treated with unilateral HTO were retrospectively reviewed. The patients were grouped according to the TXA administration method, with 24 patients in the combined group and 21 in the solo group. In the combined group, 100 mL saline containing 1 g TXA was intravenously administered before application of a tourniquet, and 20 mL saline containing 2 g TXA was injected through a drainage tube after closure of the incision. Alternatively, 100 mL of saline containing 1 g TXA was intravenously administered before application of a tourniquet in the solo group. The blood loss and adverse events were compared between the two groups.Results: All patients were followed for more than half a year. The drainage volume on the first day and total blood loss on the second day after surgery in the combined and single treatment groups were 130.06 AE 29.22 and 165.35 AE 43.08 mL (P < 0.05), respectively, and 327.17 AE 64.26 and 385.45 AE 63.31 mL (P < 0.05). There were no blood transfusions in either group. One case of delayed incision healing was observed in the solo group, and no such event occurred in the combined group. There were no significant differences between the two groups in terms of the following factors: the activated partial thromboplastin time (APTT) and prothrombin time (PT); levels of fibrinogen (FIB) and D-dimer on the second day after surgery; numbers of hospitalization days and thromboembolism events; and knee joint function and visual analog score 6 months after surgery.Conclusion: Intravenous combined with topical TXA administration in HTO is superior to intravenous administration alone for reducing postoperative blood loss and drainage volume without thromboembolic complications. However, even with only intravenous TXA administration, no cases of blood transfusion and only 1 case of incision complication occurred. At the same time, the combined use of TXA did not improve the recovery of knee joint function and pain relief after HTO.

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Section: Discussionmentioning

confidence: 99%

Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case‐Control Study

Guo

et al. 2020

Orthopaedic Surgery

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“…Some scholars have suggested that when TXA is used topically in the joint cavity, joint cavity drainage must not be placed after surgery, to avoid loss of drug efficacy 23,24 . Therefore, to reduce the bias in the test results, a temporary clamping scheme for the drainage tube for 4 h after operation was used in this study 11,25 . Given the encouraging results for TXA, the purpose of this study was to confirm which approach was more effective and safe in complex tibial plateau fracture.…”

Section: Discussionmentioning

confidence: 99%

“…Five minutes prior to final tourniquet release, the topical group received 3.0 g TXA in 75 mL of physiological saline solution and the IV group received 75 mL of saline solution directly on the wound. The therapeutic doses of these regimens were determined from previous studies [9][10][11][12] .…”

Section: Interventionmentioning

confidence: 99%

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

Wang¹,

Yupu²,

Wang³

et al. 2020

Preprint

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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. 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. 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.

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“…Some scholars have suggested that when TXA is used topically in the joint cavity, joint cavity drainage must not be placed after surgery, to avoid loss of drug e cacy 23,24 . Therefore, to reduce the bias in the test results, a temporary clamping scheme for the drainage tube for 4 h after operation was used in this study 11,25 .…”

Section: Discussionmentioning

confidence: 99%

“…Five minutes prior to nal tourniquet release, the topical group received 3.0 g TXA in 75 mL of physiological saline solution and the IV group received 75 mL of saline solution directly on the wound. The therapeutic doses of these regimens were determined from previous studies [9][10][11][12] .…”

Section: Interventionmentioning

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

et al. 2020

Preprint

View full text Add to dashboard Cite

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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The safest and most efficacious route of tranexamic acid administration in total joint arthroplasty: A systematic review and network meta-analysis

Cited by 56 publications

References 18 publications

Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case‐Control Study

Intravenous Combined with Topical Tranexamic Acid Administration Has No Additional Benefits Compared with Intravenous Administration Alone in High Tibial Osteotomy: A Retrospective Case‐Control Study

Comparison of the effectiveness and safety of different 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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