Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement

Goldstein, Matthias; Feldmann, Carsten; Wulf, Hinnerk; Wiesmann, Thomas

doi:10.3238/arztebl.2017.0824

Cited by 37 publications

(58 citation statements)

References 40 publications

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“…Meanwhile, goal directed therapy represents the current standard (128,129). Along with these changes, the use of additional medication such as Tranexamic acid (TXA) have been shown to be important in acute hemorrhage conditions; some suggest an enhancement of clot formation (130), a group of patients presenting with depletion of fibrinolysis treated with TXA to develop a significantly improved fibrin clot strength (117,(131)(132)(133)(134)(135).…”

Section: Published Guidelinesmentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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Objectives Sustained changes in resuscitation and transfusion management have been observed since the turn of the millennium, along with an ongoing discussion of surgical management strategies. The aims of this study are threefold: a) to evaluate the objective changes in resuscitation and mass transfusion protocols undertaken in major level I trauma centers; b) to summarize the improvements in diagnostic options for early risk profiling in multiply injured patients and c) to assess the improvements in surgical treatment for acute major fractures in the multiply injured patient. Methods I. A systematic review of the literature (comprehensive search of the MEDLINE, Embase, PubMed, and Cochrane Central Register of Controlled Trials databases) and a concomitant data base (from a single Level I center) analysis were performed. Two authors independently extracted data using a pre-designed form. A pooled analysis was performed to determine the changes in the management of polytraumatized patients after the change of the millennium. II. A data base from a level I trauma center was utilized to test any effects of treatment changes on outcome. Inclusion criteria: adult patients, ISS > 16, admission < less than 24 h post trauma. Exclusion: Oncological diseases, genetic disorders that affect the musculoskeletal system. Parameters evaluated were mortality, ICU stay, ICU complications (Sepsis, Pneumonia, Multiple organ failure). Results I. From the electronic databases, 5141 articles were deemed to be relevant. 169 articles met the inclusion criteria and a manual review of reference lists of key articles identified an additional 22 articles. II. Out of 3668 patients, 2694 (73.4%) were male, the mean ISS was 28.2 (SD 15.1), mean NISS was 37.2 points (SD 17.4 points) and the average length of stay was 17.0 days (SD 18.7 days) with a mean length of ICU stay of 8.2 days (SD 10.5 days), and a mean ventilation time of 5.1 days (SD 8.1 days). Both surgical management and nonsurgical strategies have changed over time. Damage control resuscitation, dynamic analyses of coagulopathy and lactate clearance proved to sharpen the view of the worsening trauma patient and facilitated the prevention of further complications. The subsequent surgical care has become safer and more balanced, avoiding overzealous initial surgeries, while performing early fixation, when patients are physiologically stable or rapidly improving. Severe chest trauma and soft tissue injuries require further evaluation. Conclusions Multiple changes in management (resuscitation, transfusion protocols and balanced surgical care) have taken place. Moreover, improvement in mortality rates and complications associated with several factors were also observed. These findings support the view that the management of polytrauma patients has been substantially improved over the past 3 decades.

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Section: Published Guidelinesmentioning

confidence: 99%

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Pape

Halvachizadeh

Leenen

et al. 2019

Injury

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“…TXA has been used effectively across different specialties in surgery to reduce blood loss [7] , [9] . Recent systematic reviews have demonstrated TXA to be effective in reducing blood loss and transfusion rates in lower limb arthroplasty and spinal surgery [10] , [11] , [12] . Most recently, clinical trials investigating its use in shoulder arthroplasty have shown favourable results [13] , [14] , [15] , [16] , [17] , [18] .…”

Section: Introductionmentioning

confidence: 99%

The use of intra-operative tranexamic acid in shoulder surgery: Protocol for a systematic review and meta-analysis

Hartland

Teoh

Rashid

2020

International Journal of Surgery Protocols

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“…5,10 Patient-specific instrumentation (PSI) emerged in the last two decades as an alternative to CI, aiming to improve accuracy and cost effectiveness in daily use, as well as reduce operating times, and blood loss caused by TKA. 1,3,5,8,12,13 TKA frequently presents perioperative blood losses, due to soft-tissue dissection and bone cuts, [14][15][16][17][18] estimated between 1,500 and 2,000 mL, with a predictable decrease of 3 g/dL of hemoglobin (Hb) for every 1,000 mL of blood loss. 12,19 Blood loss increases morbidity, mortality and dissatisfaction of patients but it also prolongs hospital admission and increases costs.…”

mentioning

confidence: 99%

“…9,15,16,19,20,[22][23][24][25] Current literature supports the use of TXA in patients undergoing TKA, as reducing blood loss will minimize complications and hospital costs. 14,15,17,21,[23][24][25][26][27][28] Despite some initial fear that it might induce thrombotic events, the widespread use of TXA has confirmed its safety, corroborated by many studies, although no consensus has been reached on doses or forms of administration in TKA. 16,[24][25][26][27] Recent studies have concluded that individual characteristics influence TXA action on TKA differently, presenting worse results in terms of blood loss in patients with lower body mass index (BMI).…”

mentioning

confidence: 99%

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

et al. 2021

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Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.

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Tranexamic Acid Prophylaxis in Hip and Knee Joint Replacement

Cited by 37 publications

References 40 publications

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

Timing of major fracture care in polytrauma patients – An update on principles, parameters and strategies for 2020

The use of intra-operative tranexamic acid in shoulder surgery: Protocol for a systematic review and meta-analysis

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

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