Topical versus intravenous tranexamic acid in total knee arthroplasty

Meena, Sanjay; Benazzo, Francesco; Dwivedi, Saumitra; Ghiara, Matteo

doi:10.1177/2309499016684300

Cited by 16 publications

(12 citation statements)

References 43 publications

(68 reference statements)

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“…Our outcomes are consistent with those of many previous studies, which found that TXA will not increase the incidence of symptomatic DVT or PE with the use of TXA in TKA at any dose, timing, or route of administration. [ 24 – 27 ]…”

Section: Discussionmentioning

confidence: 99%

The efficacy of combined intra-articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty

Wang

Shen²

2017

Medicine

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Background:This meta-analysis aimed to illustrate the efficacy and safety of combined topical and intravenous (IV) tranexamic acid (TXA) for blood loss control in primary total knee arthroplasty (TKA) patients.Methods:In April 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TKA surgery in studies that compared combined topical and IV TXA versus placebo, topical, or IV TXA alone were retrieved. The primary endpoint was the need for transfusion, total blood loss, hemoglobin drop, and the occurrence of deep venous thrombosis (DVT), pulmonary embolism (PE), and the infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.Results:Seven clinical studies were ultimately included in the meta-analysis. Compared with IV TXA and control group, combined TXA was associated with less need for transfusion, blood loss, and hemoglobin drop (P < .05). There was no significant difference between the combined TXA and topical TXA in terms of the need for transfusion, total blood loss, and hemoglobin drop (P > .05). There was no significant difference between the complications (DVT, PE, and infection) between the combined TXA, IV TXA, topical TXA, and control group.Conclusions:Current meta-analysis suggests that the combined IV and topical TXA was superior than IV TXA or control group. There is still need for more studies to identify whether combined TXA was superior than topical TXA alone.

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Section: Discussionmentioning

confidence: 99%

The efficacy of combined intra-articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty

Wang

Shen²

2017

Medicine

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“…The relative disadvantage of combined TXA application is the prolonged operative time needed for joint injection. Meena et al [51] in their meta-analysis study examined eight randomised clinical trials with 857 patients for the efficacy and safety of intraarticular TXA compared with IV route. These authors found that topical TXA has a similar efficacy to IV TXA in reducing total blood loss, drain output, transfusion rate and haemoglobin drop without any increase in thromboembolic complications.…”

Section: Comparison Between Local and IV Applicationmentioning

confidence: 99%

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Georgiev

Tanchev

Zheleva

et al. 2018

Journal of Orthopaedic Translation

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PurposeMany randomised controlled trials and meta-analysis studies have presented the efficacy of tranexamic acid (TXA) without an increase of complications. However, questions still remain about the type of administration, optimal dose and secondary outcomes of TXA in total hip arthroplasty and total knee arthroplasty. The aim of this review is to summarise the existing information in literature concerning the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use.MethodsA literature review containing 63 articles from the PubMed data starting from the first description of tranexamic acid until now was made in trying to present the existing information in a simple and effective way.ResultsTXA leads to statistically significant reduction of peri and postoperative bleeding and in that way decreases blood transfusion rates and the infection risk. Topical and intravenous (IV) use of TXA revealed similar results, with no increase of deep venous thrombosis. Therefore, topical TXA could be a reasonable alternative in patients with contraindications for IV application of TXA.ConclusionsBlood loss control with TXA, a synthetic analogue of the amino acid lysine, may be an excellent and safe alternative to allogeneic blood transfusion after total hip arthroplasty and total knee arthroplasty. Further studies are needed to establish the efficacy of combined IV and topical administration of TXA with regard to diminishing blood loss and reducing hospital stay.The Translational Potential of this ArticleThis review briefly presents the pharmacological characteristics of TXA, forms, doses, types of application and contraindications for its use with regard to diminishing blood loss and reducing hospital stay for better therapeutic strategies in orthopaedics.

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“…[7,12] TXA is thought to be of particular effects because of the significance of keeping balance between the fibrinolytic and procoagulant system both intraoperatively and postoperatively. Many clinical studies [13–15] and meta-analyses [16,17] have previously confirmed that the intravenous and topical administrations of TXA were effective on minimizing the risks of anemia and transfusion rate.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of oral tranexamic acid in total knee arthroplasty

Guo

He²,

Wang

et al. 2018

Medicine

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Our meta-analysis suggested that the administration of oral TXA provided significantly better results with respect to Hb drop, Hct drop, and drain output without increasing the transfusion rate and the risk of thromboembolic complications after TKA. Nevertheless, our current study with some limitations such as the small sample size only provided limited quality of evidence, confirmation from further meta-analysis with large-scale, well-designed RCTs is required.

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Topical versus intravenous tranexamic acid in total knee arthroplasty

Cited by 16 publications

References 43 publications

The efficacy of combined intra-articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty

The efficacy of combined intra-articular and intravenous tranexamic acid for blood loss in primary total knee arthroplasty

Comparison of topical and intravenous administration of tranexamic acid for blood loss control during total joint replacement: Review of literature

Efficacy and safety of oral tranexamic acid in total knee arthroplasty

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