Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Fillingham, Yale A.; Ramkumar, Dipak B.; Jevsevar, David S.; Yates, Adolph J.; Bini, Stefano A.; Clarke, Henry D.; Schemitsch, Emil H.; Johnson, Rebecca L.; Memtsoudis, Stavros G.; Sayeed, Siraj A.; Sah, Alexander P.; Valle, Craig J. Della

doi:10.1016/j.arth.2018.08.002

Cited by 131 publications

(111 citation statements)

References 15 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…Therefore, our results may not be relevant to this patient group. Some medical centres provide TXA to such patients, in contrast to the more conservative approach common at many hospitals worldwide and formally recommended by Chinese and American orthopaedic associations . Since some retrospective studies have suggested that TXA can be safe and beneficial in such patients, future work should be performed to confirm this issue with prospective design.…”

Section: Discussionmentioning

confidence: 99%

“…Patients were excluded if they met any of the following criteria: (1) history of venous thromboembolism (deep vein thrombosis, pulmonary embolism), (2) clotting disorders, (3) cardio‐ or cerebrovascular conditions (history of myocardial infraction or stroke) within the previous 3 months, (4) known allergy to TXA, or (5) serious liver or kidney dysfunction. These exclusion criteria reflect conservative guidelines that recommend using TXA cautiously in patients at high risk of thrombosis. After exclusion of patients undergoing bilateral or revision arthroplasty and patients with other contraindications, a total of 7667 patients were included (Figure ).…”

Section: Methodsmentioning

confidence: 99%

“…TXA was administered before the incision to inhibit fibrinolytic activity at the initial stage and minimize blood loss, and to take into account the time needed for systemic TXA concentration to peak after injection . In fact, guidelines of the American Association of Hip and Knee Surgeons recommend that TXA be administered prior to incision in primary total joint arthroplasty to reduce blood loss and transfusion requirement …”

Section: Methodsmentioning

confidence: 99%

“…TXA can be administered intravenously, topically, orally or by a combination of these routes . Intravenous administration is the most frequent route, but concerns over risk of thromboembolic events have led to interest in topical administration, and several studies have investigated the advantages of combining intravenous and topical methods . Few studies have compared all three routes of TXA administration head‐to‐head, and safety of TXA in THA still needs confirmation in larger samples.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

show abstract

“…It reversibly binds plasminogen receptors, inhibiting the proteolytic activity of plasmin and subsequent breakdown of fibrin. Food and Drug Administration approval is for menorrhagia, and bleeding prophylaxis in haemophilia and von Willebrand disease 1 2. TXA is widely used in multiple surgical settings to minimise blood loss and need for blood transfusions.…”

Section: Introductionmentioning

confidence: 99%

Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

Kaptein¹

2019

BMJ Case Rep

View full text Add to dashboard Cite

Tranexamic acid (TXA) is an antifibrinolytic which minimises bleeding and transfusions, with thrombotic risk. Our patient had known coronary artery disease with post-TXA acute ST-elevation myocardial infarction (STEMI) due to in-stent thrombosis. He had five drug-eluting stents (DES): two overlapping DES in mid-LAD (3 years ago), and two overlapping DES in distal right coronary artery and one DES in obtuse-marginal (1.5 years ago). After TXA, both overlapping stent locations thrombosed. Of nine reports of post-TXA acute MI, only one had complex stent anatomy (bifurcation stent to left circumflex/first obtuse-marginal) with other single stents, and only the complex stent thrombosed. Post-TXA MI was more often STEMI caused by arterial thrombosis, rather than non-STEMI caused by blood loss, hypotension or demand ischaemia. Overlapping and bifurcation stents thrombosed; single stents remained patent. In conclusion, overlapping stents, bifurcation stents, excessive stent length and previous in-stent restenosis/thrombosis may increase thrombotic risk. TXA should be administered cautiously with complex stent anatomy.

show abstract

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Halme,

Roshanov,

Tornberg

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceAlthough major bleeding is among the most common and prognostically important perioperative complications, the relative timing of bleeding events is not well established. This information is critical for preventing bleeding complications and for informing the timing of pharmacologic thromboprophylaxis.ObjectiveTo determine the timing of postoperative bleeding among patients undergoing surgery for up to 30 days after surgery.Design, Setting, and ParticipantsThis is a secondary analysis of a prospective cohort study. Patients aged 45 years or older who underwent inpatient noncardiac surgery were recruited in 14 countries between 2007 and 2013, with follow-up until December 2014. Data analysis was performed from June to July 2023.ExposureNoncardiac surgery requiring overnight hospital admission.Main Outcomes and MeasuresThe primary outcome (postoperative major bleeding) was a composite of the timing of the following bleeding outcomes: (1) bleeding leading to transfusion, (2) bleeding leading to a postoperative hemoglobin level less than 7 g/dL, (3) bleeding leading to death, and (4) bleeding associated with reintervention. Each of the components of the composite primary outcome (1-4) and bleeding independently associated with mortality after noncardiac surgery, which was defined as a composite of outcomes 1 to 3, were secondary outcomes.ResultsAmong 39 813 patients (median [IQR] age, 63.0 [54.8-72.5] years; 19 793 women [49.7%]), there were 5340 major bleeding events (primary outcome) in 4638 patients (11.6%) within the first 30 days after surgery. Of these events, 42.7% (95% CI, 40.9%-44.6%) occurred within 24 hours after surgery, 77.7% (95% CI, 75.8%-79.5%) by postoperative day 7, 88.3% (95% CI, 86.5%-90.2%) by postoperative day 14, and 94.6% (95% CI, 92.7%-96.5%) by postoperative day 21. Within 48 hours of surgery, 56.2% of major bleeding events, 56.2% of bleeding leading to transfusion, 56.1% of bleeding independently associated with mortality after noncardiac surgery, 51.8% of bleeding associated with hemoglobin less than 7 g/dL, and 51.8% of bleeding associated with reintervention had occurred.Conclusions and RelevanceIn this cohort study, of the major postoperative bleeding events in the first 30 days, more than three-quarters occurred during the first postoperative week. These findings are useful for researchers for the planning future clinical research and for clinicians in prevention of bleeding-related surgical complications and in decision-making regarding starting of pharmacologic thromboprophylaxis after surgery.

show abstract

Tranexamic Acid Use in Total Joint Arthroplasty: The Clinical Practice Guidelines Endorsed by the American Association of Hip and Knee Surgeons, American Society of Regional Anesthesia and Pain Medicine, American Academy of Orthopaedic Surgeons, Hip Society, and Knee Society

Cited by 131 publications

References 15 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

Acute ST-elevation myocardial infarction due to in-stent thrombosis after administering tranexamic acid in a high cardiac risk patient

Timing of Major Postoperative Bleeding Among Patients Undergoing Surgery

Contact Info

Product

Resources

About