Tranexamic acid: more evidence for its use in joint replacement surgery

Raveendran, Raviraj; Wong, Jean

doi:10.1111/trf.12494

Cited by 18 publications

(18 citation statements)

References 11 publications

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“…Previous articles have indicated that no increased risk of DVT or PE were observed when topical or intravenous administration of TXA. [ 31 ] All the included studies in our studies also showed no significant difference in the incidence rate of DVT or PE in the combined groups which was in accordance with the previous studies. However, due to the small amount of the included studies, more RCTs with longer follow up are required to confirm our conclusion.…”

Section: Discussionsupporting

confidence: 92%

Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?

Yang

Du²,

Sun³

2017

Medicine

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Background:To compare the efficacy and safety of the combined application of both intravenous and topical tranexamic acid (TXA) versus the single use of either application in patients with total knee and hip arthroplasty (TKA and THA).Methods:Potentially relevant studies were identified from electronic databases including Medline, PubMed, Embase, ScienceDirect, and the Cochrane Library. Randomized control trials (RCTs) of patients prepared for total joint arthroplasty that compared combined TXA with placebo were retrieved. The primary endpoint was hemoglobin decline or postoperative hemoglobin level, blood loss, drainage volume, transfusion requirements. The secondary outcomes were length of stay (LOS), and operation time as well as surgery-related adverse effects, such as wound infection, deep vein thrombosis (DVT), and pulmonary embolism (PE). After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.Results:Five RCTs that included 604 patients met the inclusion criteria. The present meta-analysis indicated significant differences existed in the total blood loss (mean difference [MD] = −134.65, 95% CI: −191.66 to −77.64, P < .0001), postoperative hemoglobin level (MD = 0.74, 95% CI: 0.39–1.10, P < .0001), drainage volume (MD = −47.44, 95% CI: −64.55 to −30.33, P < .00001), and transfusion rate (risk difference [RD] = −0.06, 95% CI: −0.10 to −0.02, P = .006) between groups.Conclusion:Combined administration of TXA in TKA and THA was associated with significantly reduced total blood loss, postoperative hemoglobin decline, drainage volume, and transfusion requirements. Well-designed, high-quality RCTs with long-term follow-up are still required.

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Section: Discussionsupporting

confidence: 92%

Is combined topical and intravenous tranexamic acid superior to single use of tranexamic acid in total joint arthroplasty?

Yang

Du²,

Sun³

2017

Medicine

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“…21,22 Its increasing use has almost eliminated the need for other blood conservation strategies such as erythropoietin administration, pre-operative autologous donation and intra- or post-operative blood salvation. There is still some debate on which is the better use, locally or generally administrated, whilst one demonstrates that there is no contra-indication for intravenous tranexamic acid in patients with a history of venous thromboembolism.…”

Section: Overview Of Advances In Thamentioning

confidence: 99%

Advances in hip arthroplasty surgery: what is justified?

Zagra

2017

EFORT Open Reviews

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Total hip arthroplasty (THA) surgery has shown dramatic changes in terms of increased number of procedures and of technical development in recent years. It has been described as “the operation of the 20th century” for the excellent results, the high satisfaction of the patients and the improvement of the quality of life.A lot of variations have been introduced over the last few decades in THA especially in terms of indications (both in younger and older patients), techniques and devices (approaches, tissue preservation, biomaterials and industrial finishing), per-operative management (blood loss and pain control) and post-operative protocols (the so called “fast track” surgery). Looking at all these advances the emerging question is: have all of them been justified both in terms of improvement of the results for the patients and of the cost/benefit ratio from an economical point of view?The purpose of this paper is to critically analyse the advantages and the disadvantages of the theoretically proposed “advances in hip arthroplasty” and attempt to understand which are justified of such “advances” nowadays, based on the international and the European perspective with a focus on the author’s personal clinical experience.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.170008. Originally published online at www.efortopenreviews.org

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“…Several evidence-based mechanisms have been applied to reduce bleeding and blood loss: the preoperative intravenous (IV) administration of antifibrinolytic tranexamic acid (TXA), the use of spinal anesthesia 2 , and the use of a specialized bandaging technique after knee replacement 3 . Preoperative IV administration of TXA was demonstrated to reduce total blood loss considerably, as determined in a meta-analysis of 19 randomized controlled trials of IV TXA 4 , and also was shown to significantly lower the need for blood transfusion 5,6 . The antifibrinolytic duration after IV administration of TXA is relatively short, 3 to 4 hours 7,8 , considering the duration of postoperative bleeding.…”

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confidence: 97%