Transfusions and cost-benefit of oral versus intravenous tranexamic acid in primary total hip arthroplasty

Wang, Ning; Xiong, Xiang; Xu, Li; Ji, Ming; Yang, Tao; Tang, Jin; Yang, Yong; Liu, Wangwei; Chen, Hongxia

doi:10.1097/md.0000000000015279

Cited by 16 publications

(13 citation statements)

References 37 publications

(73 reference statements)

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“…Treatment with tranexamic acid has been used to reduce blood loss and transfusion rates in orthopedic surgery. [28][29][30] However, our protocol focused not only on blood conservation management but also on reproduction by inducing erythropoiesis. 2,6) Despite the PBM protocol, in the fracture patients, the hemoglobin level declined until the postoperative day 3, which was followed by a gradual increase.…”

Section: Discussionmentioning

confidence: 99%

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

et al. 2021

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Backgroud Hip fracture surgery is associated with blood loss, which may lead to adverse patient outcomes. The hemoglobin level declines gradually in most hip fracture cases involving femoral neck fractures and intertrochanteric fractures. It decreases further after hip fracture surgery due to perioperative bleeding. We developed a protocol, which avoids transfusion in hip fracture surgery, and reviewed the hemodynamic outcomes of patients with hemoglobin less than 10 g/dL without transfusion. Methods From 2014 to 2019, we retrospectively recruited 34 patients with hip fractures and a hemoglobin level less than 10 g/dL, who refused to undergo transfusion. There were 19 patients with femoral neck fractures and 15 patients with intertrochanteric fractures. Our patient blood management (PBM) protocol involving 4,000 U erythropoietin (3 times a week) and 100 mg iron supplement (every day) was applied to all included patients. Intraoperatively, a cell saver and tranexamic acid were used. Postoperatively, the protocol was maintained until the patients' hemoglobin level reached 10 g/dL. We evaluated the feasibility of our protocol, perioperative complications, and hemodynamic changes. Results Nineteen patients with femoral neck fractures underwent bipolar hemiarthroplasty and 15 patients with intertrochanteric fractures underwent internal fixation with a cephalomedullary nail. The mean hemoglobin level was 8.9 g/dL (range, 7.3–9.9 g/dL) preoperatively, 7.9 g/dL (range, 6.5–9.3 g/dL) immediately postoperatively, 7.7 g/dL (range, 4.3–9.5 g/dL) on postoperative day 1, 7.4 g/dL (range, 4.2–9.4 g/dL) on postoperative day 3, 8.1 g/dL (range, 4.4–9.7 g/dL) on postoperative day 5, 8.5 g/dL (range, 4.5–9.9 g/dL) on postoperative day 7, and 9.9 g/dL (range, 5.7–11.1 g/dL) on postoperative day 14. The average intraoperative bleeding was 206.2 ± 78.7 mL. There was no case associated with complications of anemia. Conclusions Hip fracture surgery in patients with hemoglobin less than 10 g/dL was feasible without the need for transfusion using our PBM protocol in 34 patients. Using this protocol, the operation was conducted safely despite the anemic condition of patients with fractures whose hemoglobin was less than 10 g/dL.

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Section: Discussionmentioning

confidence: 99%

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

et al. 2021

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“…These savings are largely associated with a reduction in blood transfusions and their associated costs. 8,13,14 Reduced length of stay and improvements in early functional outcomes have also been reported. 15,16 A cost analysis was undertaken in conjunction with this trial.…”

Section: Introductionmentioning

confidence: 93%

“…[2][3][4][5][6][7] Highrisk patients such as those with previous venous thromboembolism (VTE), myocardial infarction (MI), and cerebrovascular accidents (CVAs) have been excluded from orthopaedic trials to date. 8 Various dosing regimens have also been described, with support in the literature for extending oral or intravenous (IV doses of TXA to reduce blood loss further and potentially improve patient outcomes. 9,10 The most effective regime, however, remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Using tranexamic acid for an additional 24 hours postoperatively in hip and knee arthroplasty saves money: a cost analysis from the TRAC-24 randomized control trial

Karayiannis

Agus²,

Bryce

et al. 2022

Bone & Joint Open

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Aims Tranexamic acid (TXA) is now commonly used in major surgical operations including orthopaedics. The TRAC-24 randomized control trial (RCT) aimed to assess if an additional 24 hours of TXA postoperatively in primary total hip (THA) and total knee arthroplasty (TKA) reduced blood loss. Contrary to other orthopaedic studies to date, this trial included high-risk patients. This paper presents the results of a cost analysis undertaken alongside this RCT. Methods TRAC-24 was a prospective RCT on patients undergoing TKA and THA. Three groups were included: Group 1 received 1 g intravenous (IV) TXA perioperatively and an additional 24-hour postoperative oral regime, Group 2 received only the perioperative dose, and Group 3 did not receive TXA. Cost analysis was performed out to day 90. Results Group 1 was associated with the lowest mean total costs, followed by Group 2 and then Group 3. The differences between Groups 1 and 3 (-£797.77 (95% confidence interval -1,478.22 to -117.32) were statistically significant. Extended oral dosing reduced costs for patients undergoing THA but not TKA. The reduced costs in Groups 1 and 2 resulted from reduced length of stay, readmission rates, emergency department attendances, and blood transfusions. Conclusion This study demonstrated significant cost savings when using TXA in primary THA or TKA. Extended oral dosing reduced costs further in THA but not TKA. Cite this article: Bone Jt Open 2022;3(7):536–542.

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“…Several studies have reported that perioperative intravenous infusion of TXA can reduce total blood loss, intraoperative blood loss, and blood transfusion rate during joint replacement surgery, and that it does not increase the risk of venous thrombosis. Its safety has been recognized by clinical experts [4][5][6][7]. fracture surgery.…”

Section: Introductionmentioning

confidence: 99%

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

Wang¹,

Yang²,

Zhu³

et al. 2020

Preprint

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Backgroud: some studys have reported that topical use of TXA can reduce perioperative blood loss in acetabular fracture surgery. We aim to investigate the effect of intravenous administration of tranexamic acid (TXA) on perioperative blood loss during acetabular fracture surgery Methods From January 2016 to May 2020, 85 patients undergoing surgical treatment with intravenous TXA administration for acetabular fractures at our department were retrospectively analyzed. The patients were divided into three groups according to dosage of TXA: Single treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery (n = 33), repeated treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery and intravenous infusion of TXA (10 mg/kg) at 3 h (n = 26), and multiple treatment group: patients receiving intravenous infusion of TXA (15 mg/kg) 20 min before surgery and intravenous infusion of TXA (10 mg/kg) at 3 and 6 h (n = 26). Total blood loss, intraoperative blood loss, postoperative hemoglobin drop, surgery-related transfusion rate, postoperative thrombosis rate, and operation time were compared among these three groups Results Total blood loss, intraoperative blood loss, postoperative hemoglobin drop, and drainage volume in the single treatment group, repeated treatment group, and multiple treatment group were 932.7.0 ± 181.8 ml, 624.2 ± 138.7 ml, 32.2 ± 5.3 g/l, and 100.1 ± 30.1 ml; 843.4 ± 153.0 ml, 567.3 ± 144.1 ml, 27.6 ± 3.8 g/l, and 86.1 ± 42.2 ml; and 748.0 ± 145.2 ml, 521.1 ± 98.1 ml, 24.4 ± 4.4 g/l, and 64.8 ± 29.0 ml, respectively; the values were significantly different between groups (P < 0.05). The surgery-related blood transfusion rates in the single treatment, repeated treatment, and multiple treatment groups were 51.5% (17/33), 23.0% (6/26), 19.2% (5/26), respectively. There was no statistically significant difference in surgery-related blood transfusion rates between groups Conclusions Intravenous administration of TXA in acetabular fracture surgery can reduce total blood loss, intraoperative blood loss, and postoperative hemoglobin drop without increasing the risk of venous thrombosis. Multiple administrations before surgery, and at 3 h and 6 h during surgery are more effective than single and repeated administration

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Transfusions and cost-benefit of oral versus intravenous tranexamic acid in primary total hip arthroplasty

Cited by 16 publications

References 37 publications

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

Hip Fracture Surgery without Transfusion in Patients with Hemoglobin Less Than 10 g/dL

Using tranexamic acid for an additional 24 hours postoperatively in hip and knee arthroplasty saves money: a cost analysis from the TRAC-24 randomized control trial

Intravenous administration of tranexamic acid to reduce blood loss during perioperative period in acetabular fracture surgery

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