Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain

Raveendran, Raviraj; Wong, Jean

doi:10.1136/eb-2012-100872

Cited by 29 publications

(29 citation statements)

References 5 publications

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“…In addition, concerns still exist about the safety of TXA in primary unilateral THA. 15,32 The present study therefore substantially extends our own previous work and the literature more broadly by comparing, in a large sample, the efficacy of TXA administered topically, intravenously or both.…”

Section: Discussionsupporting

confidence: 68%

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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

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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.

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Section: Discussionsupporting

confidence: 68%

“…While routes of TXA administration have been compared for total knee arthroplasty by our own group, few studies have directly compared the three routes in THA. In addition, concerns still exist about the safety of TXA in primary unilateral 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

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“…It has been used successfully in orthopedic surgery via an intravenous route, with several studies showing significant reductions in bleeding and risk of transfusion after TKA and THA 12-20 . However, concerns remain over the risk of thromboembolic complications after systemic administration 5, 6 . Topical application leads to 70% lower systemic absorption, and may therefore be a safer alternative to giving it systemically 8 .…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been isolated case reports of thrombus formation, which has generated concerns over the risk of thromboembolic complications in a patient population already at high risk for deep vein thrombosis and pulmonary embolism. This has prevented the widespread acceptance of the use of IV antifibrinolytics in total joint replacement surgery 5, 6 . Topical application of antifibrinolytics may produce the same efficacy, but with much lower systemic absorption and thus much lower risk for thromboembolic complications.…”

Section: Introductionmentioning

confidence: 99%

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty

König

Hamlin

Waters

2013

The Journal of Arthroplasty

177

151

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The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3gm TXA per 100mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.

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“…Several clinical trials have identified that intravenous (IV) TXA is effective in reducing perioperative blood loss and the need for subsequent blood transfusions in TKA [15–17]. However, deep venous thrombosis (DVT) after the systemic administration of TXA is still a serious and fatal complication [18]. Therefore, many researchers have focused on the topical application of TXA via drain tube or intra-articular administration, and the topical application of TXA is considered an alternative effective route that entails less risk than IV after TKA [19, 20].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

Chen

Jiao

et al. 2017

J Orthop Surg Res

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BackgroundThis study aims to compare the effectiveness and safety of topical versus intravenous tranexamic acid (TXA) in reducing blood loss in primary total knee arthroplasty (TKA).MethodsPubMed, Embase, the Cochrane Library, Web of Science, Chinese Biomedicine Literature (CBM), Wanfang Database and China National Knowledge Infrastructure (CNKI), and Google Scholar were searched for randomized controlled studies (RCTs) that compared topical versus intravenous TXA in terms of reducing blood loss during TKA from their inception to September 2015. This systematic review and meta-analysis was performed according to PRISMA criteria.ResultsTwelve studies reporting 12 RCTs comprising 1130 patients were included. Compared with the intravenous administration of TXA, the topical administration of TXA showed no significant differences in total blood loss (MD 2.08, 95% CI −68.43 to 72.60, P = 0.95), blood loss in drainage (MD 18.49, 95% CI −40.01 to 76.98, P = 0.54), hidden blood loss (MD 4.75, 95% CI −337.94 to 347.44, P = 0.99), need for transfusion (RR = 0.92, 95% CI 0.67~1.25, P = 0.58), hemoglobin (Hb) decline (MD −0.42, 95% CI −0.89 to 0.05, P = 0.08), and DVT occurrence (RR = 1.17, 95% CI 0.55~2.50, P = 0.68).ConclusionsCompared with intravenous administration TXA, topical administration TXA exhibits comparable effectiveness and safety in terms of reducing blood loss during TKA. Due to the poor quality of the included studies, more high-quality RCTs are needed to identify the optimal method and dose of TXA after TKA.

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Tranexamic acid reduces blood transfusion in surgical patients while its effects on thromboembolic events and mortality are uncertain

Abstract: Commentary on: Ker K, Edwards P, Perel P, et al. Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis. BMJ 2012;344:e3054.

Cited by 29 publications

References 5 publications

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

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

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty

Comparison of the effectiveness and safety of topical versus intravenous tranexamic acid in primary total knee arthroplasty: a meta-analysis of randomized controlled trials

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