Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

North, W. Trevor; Mehran, Nima; Davis, Jason J.; Silverton, Craig D.; Weir, Robb M.; Laker, Michael W.

doi:10.1016/j.arth.2015.12.001

Cited by 31 publications

(16 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The scores demonstrated that the trials were of a high quality (Jadad score ≥3). Two studies 21 , 23 were double-blinded whereas the Xie and colleagues study was not. 22 …”

Section: Resultsmentioning

confidence: 99%

“…In addition, uncertainty still remains because of the difference of DVT and PE screening methods in the studies. Doppler Ultrasound was routinely used in the Wei and colleagues 21 and Xie and colleagues 22 studies but not in the North and colleagues 23 study, where only symptomatic patients were investigated. This may have resulted in the under diagnosis of thromboembolic events in this study.…”

Section: Results Of Meta-analysismentioning

confidence: 99%

“…Xie and colleagues 22 used 3 g TA in 150 mL normal saline; 50 mL were placed in the acetabulum and 50 mL in the femoral canal (soaked gauze) with the remaining 50 mL injected into the joint after closure of the fascia. North and colleagues 23 used 2 g of TA in 100 mL normal saline. The whole amount was placed in the hip after component placement and allowed to sit undisturbed for 5 minutes.…”

Section: Results Of Meta-analysismentioning

confidence: 99%

See 2 more Smart Citations

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

2016

Orthop Rev

View full text Add to dashboard Cite

Tranexamic acid (TA) is widely used by orthopedic surgeons to decrease blood loss and the need for transfusion following total hip arthroplasty (THA). Although both intravenous and topical applications are described in the literature, there remains no consensus regarding the optimal regimen, dosage and method of delivery of TA during THA. In addition, concerns still exist regarding the risk of thromboembolic events with intravenous administration. The purpose of this meta-analysis was to compare the efficacy and safety of topical versus intravenous administration of TA in THA. A systemic review of the electronic databases PubMed, CENTRAL, EMBASE and Google Scholar was undertaken to identify all randomized controlled trials (RCTs) comparing the topical and intravenous administration of TA during THA, in terms of total blood loss, rate of blood transfusion and incidence of deep venous thrombosis (DVT) and pulmonary embolism (PE) post-operatively. A meta-analysis was performed to evaluate and compare the efficacy and safety of both methods of administration. Of 248 potentially relevant papers, three RCTs comprising (482) were eligible for data extraction and meta-analysis. The results showed a slightly higher amount of blood loss [Mean Difference (MD) – 46.37, P=0.12, 95% confidence interval (CI) – 12.54 to 105.29] and rate of transfusion (Risk Ratio 1.30, P=0.39, 95%CI 0.71 to 2.37) postoperatively in the topical TA group, but both did not reach statistical significance. There were 3 cases (1.2%) of DVT/PE in the intravenous group and one case (0.4%) in the topical group. Topical TA is an effective and safe method to reduce blood loss and the rate of transfusion following primary THA. It has comparative effectiveness to IV administration with slightly less post-operative thromboembolic complications. Larger and better-designed RCTs are required to establish the optimum dosage and regimen for topical use.

show abstract

“…The scores demonstrated that the trials were of a high quality (Jadad score ≥3). Two studies 21 , 23 were double-blinded whereas the Xie and colleagues study was not. 22 …”

Section: Resultsmentioning

confidence: 99%

Section: Results Of Meta-analysismentioning

confidence: 99%

Section: Results Of Meta-analysismentioning

confidence: 99%

See 1 more Smart Citation

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

2016

Orthop Rev

View full text Add to dashboard Cite

show abstract

“…33 Comparative efficacy of intravenous and topical TXA remains controversial. 22,29,34 In our previous study, 22 we showed that intravenous TXA was associated with lower total blood loss (878.03 vs 905.07 mL), smaller decrease in haemoglobin (3.36 vs 3.89 g/dL) and lower incidence of transfusion (4.3% vs 5.7%) than topical TXA. The differences in total blood loss and transfusion rate were not significant, perhaps because each treatment arm contained only 70 patients.…”

Section: Concerns About Thromboembolic Complications Of Intravenousmentioning

confidence: 87%

“…The efficacy of TXA in reducing blood loss and transfusion requirement has been confirmed in numerous studies but there has been debate regarding the best route of administration. 15,27 Several studies have compared the efficacy of topical and intravenous administration of TXA, 28,29 and others have compared the efficacy of combined administration versus intravenous or topical TXA in primary THA. 19,30 While routes of TXA administration have been compared for total knee arthroplasty by our own group, 31 few studies have directly compared the three routes in THA.…”

Section: Discussionmentioning

confidence: 99%

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Xie¹,

Zhang

Chen³

et al. 2019

Brit J Clinical Pharma

View full text Add to dashboard Cite

Aim This study aimed to compare the efficacy and safety of different tranexamic acid (TXA) routes following primary total hip arthroplasty (THA). Methods We collected data from the National Health Database on patients registered from January 2013 to September 2017. The patients were divided based on TXA administration route into a control group (without TXA), intravenous group, topical group and combined group. The primary outcome was transfusion; secondary outcomes were total blood loss, haemoglobin level, decrease in haemoglobin on postoperative day 3, and incidence of complications. Results Data were collected on 7667 primary THA, 4662 with TXA and 3005 without TXA. The transfusion rate was 28.7% in the control group, 12.7% in the topical group, 8.9% in the intravenous group, and 6.1% in the combined group, and the inter‐group differences were significant (P < .01). The combined group showed significantly smaller total blood loss (1.23 ± 0.52 L), smaller reduction in haemoglobin level (26.5 ± 11.1 g/L) and higher haemoglobin level on postoperative day 3 (107.0 ± 15.5 g/L) than the other three groups (P < .05). The three TXA groups showed significantly lower incidence of deep vein thrombosis than the control group (0.08% vs 0.47%, P = .001) as well as a lower rate of other complications (0.34% vs 0.67%, P = .044). Conclusion TXA is effective and safe to decrease blood loss and transfusion following primary THA, regardless of whether it is administered intravenously, topically or both. Intravenous or combined routes may produce better haemostatic effects, so they may be suggested in the absence of contraindications.

show abstract

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Gibbs

Champaneria

Geneen

et al. 2023

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Background Pelvic, hip, and long bone fractures can result in significant bleeding at the time of injury, with further blood loss if they are treated with surgical fixation. People undergoing surgery are therefore at risk of requiring a blood transfusion and may be at risk of peri‐operative anaemia. Pharmacological interventions for blood conservation may reduce the risk of requiring an allogeneic blood transfusion and associated complications. Objectives To assess the effectiveness of different pharmacological interventions for reducing blood loss in definitive surgical fixation of the hip, pelvic, and long bones. Search methods We used a predefined search strategy to search CENTRAL, MEDLINE, PubMed, Embase, CINAHL, Transfusion Evidence Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform (ICTRP) from inception to 7 April 2022, without restrictions on language, year, or publication status. We handsearched reference lists of included trials to identify further relevant trials. We contacted authors of ongoing trials to acquire any unpublished data. Selection criteria We included randomised controlled trials (RCTs) of people who underwent trauma (non‐elective) surgery for definitive fixation of hip, pelvic, and long bone (pelvis, tibia, femur, humerus, radius, ulna and clavicle) fractures only. There were no restrictions on gender, ethnicity, or age. We excluded planned (elective) procedures (e.g. scheduled total hip arthroplasty), and studies published since 2010 that had not been prospectively registered. Eligible interventions included: antifibrinolytics (tranexamic acid, aprotinin, epsilon‐aminocaproic acid), desmopressin, factor VIIa and XIII, fibrinogen, fibrin sealants, and non‐fibrin sealants. Data collection and analysis Two review authors independently assessed trial eligibility and risk of bias, and extracted data. We assessed the certainty of the evidence using GRADE. We did not perform a network meta‐analysis due to lack of data. Main results We included 13 RCTs (929 participants), published between 2005 and 2021. Three trials did not report any of our predefined outcomes and so were not included in quantitative analyses (all were tranexamic acid versus placebo). We identified three comparisons of interest: intravenous tranexamic acid versus placebo; topical tranexamic acid versus placebo; and recombinant factor VIIa versus placebo. We rated the certainty of evidence as very low to low across all outcomes. Comparison 1. Intravenous tranexamic acid versus placebo Intravenous tranexamic acid compared to placebo may reduce the risk of requiring an allogeneic blood transfusion up to 30 days (RR 0.48, 95% CI 0.34 to 0.69; 6 RCTs, 457 participants; low‐certainty evidence) and may result in little to no difference i...

show abstract

Topical vs Intravenous Tranexamic Acid in Primary Total Hip Arthroplasty: A Double-Blind, Randomized Controlled Trial

Cited by 31 publications

References 8 publications

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Topical versus intravenous administration of tranexamic acid in primary total hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials

Optimal route for administering tranexamic acid in primary unilateral total hip arthroplasty: Results from a multicenter cohort study

Pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic and long bone fractures

Contact Info

Product

Resources

About