Tranexamic acid attenuates inflammatory effect and modulates immune response in primary total knee arthroplasty: a randomized, placebo-controlled, pilot trial

Zhang, Shaoyun; Xu, Hong; Xie, Jinwei; Cao, Guorui; Lei, Yiting; Pei, Fuxing

doi:10.1007/s10787-020-00695-6

Cited by 20 publications

(32 citation statements)

References 28 publications

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“…19,[47][48][49][50] The majority of included studies were RCTs, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][35][36][37][38][39][40]43,44,[46][47][48][49][50] while five were cohort studies including a control group. 19,34,41,42,45 The participants in most of the articles were undergoing elective surgery (n ¼ 3,563) 19-39,41--47,49,50 of which 13 studies investigated total knee arthroplasty patients which, at least partly, is an inflammatory condition (n ¼ 1,918), 20,22,24,25,27,34,35,[37][38][39]42,...…”

Section: Resultsmentioning

confidence: 99%

“…19 The studies were grouped depending on the control group. Fourteen studies compared patients receiving TXA with a group receiving either placebo or no medication 19,20,25,26,29,30,32,34,36,40,42,[48][49][50] while 14 other studies compared different dosing schemes of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA.…”

Section: Resultsmentioning

confidence: 99%

“…[21][22][23][24]28,33,[37][38][39]41,43,44,46,47 Finally, five studies examined the difference of the inflammatory effect of TXA between different administration forms of TXA. 21,27,31,35,45 Inflammatory Biomarkers ►Table 1 shows a summary of the 14 included studies that investigated inflammatory markers in TXA patients and compared them to either a group receiving placebo or no medication, [19][20][21]25,26,29,30,32,34,36,40,42,[48][49][50] while ►Table 2 presents a summary of 14 articles that investigated inflammatory biomarkers in surgical patients receiving TXA and compared them to a single group or several groups receiving either fewer or lower doses of TXA. [21][22][23][24]28,33,[37][38][39]41,43,44,46,...…”

Section: Resultsmentioning

confidence: 99%

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Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Okholm

Krog

Hvas

2022

Semin Thromb Hemost

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Tranexamic acid (TXA) is an antifibrinolytic drug primarily used for reducing blood loss in patients with major bleedings. Animal and cell studies have shown that TXA might modulate the inflammatory response by either enhancing or inhibiting cytokine levels. Furthermore, recent human studies have found altered inflammatory biomarkers in patients receiving TXA when compared with patients who did not receive TXA. In this systematic review we investigated the effect of TXA on inflammatory biomarkers in different patient groups. A systematic literature search was conducted on the databases PubMed and Embase to identify all original articles that investigated inflammatory biomarkers in patients receiving TXA and compared them to a relevant control group. The review was performed according to the PRISMA guidelines, and the literature search was performed on November 29, 2021. Thirty-three studies were included, among which 14 studies compared patients receiving TXA with patients getting no medication, another 14 studies investigated different dosing regimens of TXA, and finally five studies examined the administration form of TXA. The present review suggests that TXA has an anti-inflammatory effect in patients undergoing orthopaedic surgery illustrated by decreased levels of C-reactive protein and interleukin-6 in patients receiving TXA compared with patients receiving no or lower doses of TXA. However, the anti-inflammatory effect was not found in patients undergoing cardiac surgery, pediatric craniosynostosis patients, or in rheumatoid arthritis patients. The inflammatory response was not affected by administration form of TXA (oral, intravenous, or topical). In conclusion, an anti-inflammatory effect of TXA was consistently found among orthopaedic patients only.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Tranexamic Acid and Its Potential Anti-Inflammatory Effect: A Systematic Review

Okholm

Krog

Hvas

2022

Semin Thromb Hemost

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“…However, the pain was associated not only with hemarthrosis but also with the inflammatory response. 9 Because it has been shown that TXA administration could attenuate the inflammatory response, 10 focusing on changes in inflammatory mediators may partially explain postoperative pain levels in patients undergoing ACLR.…”

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confidence: 99%

Regarding “Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: A Double-Blind, Randomized, Controlled Trial”

Zhang

Dai

Xiao

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Zhang et al indicate that a study they conducted found that TXA could attenuate the inflammatory response in patients undergoing total knee arthroplasty; however, they used 6 doses and more than 6 g, which is far greater than what is currently used in most arthroplasty centers and more closely related to what is used in cardiac surgery. 8 Our hypothesis that hemarthrosis would be a source of pain was based on the premise that it may create increased intra-articular pressure, as well as an increased local inflammatory response. Although we were, unfortunately, unsuccessful in reducing hemarthrosis, we believe that if we were successful, this would have resulted in less pain.…”

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confidence: 99%