scholarly journals Postoperative blood loss reduction in computer-assisted surgery total knee replacement by low dose intra-articular tranexamic acid injection together with 2-hour clamp drain: a prospective triple-blinded randomized controlled trial

2011 ◽  
Vol 3 (2) ◽  
pp. 12 ◽  
Author(s):  
Paphon Sa-ngasoongsong ◽  
Thanaphot Channoom ◽  
Viroj Kawinwonggowit ◽  
Patarawan Woratanarat ◽  
Pongsthorn Chanplakorn ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Controlled Trial ◽  
Computer Assisted Surgery ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Computer Assisted ◽  
Total Blood ◽  
Acid Injection ◽  
Total Knee

A high-dose local tranexamic acid has been introduced in total knee arthroplasty for bleeding control. We are not sure about the systemic absorption and side effects. The aim of this study was to evaluate the effect of low dosage of intra-articular tranexamic acid injection combined with 2-hour clamp drain in minimally bleeding computer-assisted surgery total knee replacement (CAS-TKR). A prospective randomized controlled trial was conducted in a total of 48 patients underwent CAS-TKR. The patients were randomly assigned to receive either of a mixed intra-articular solution of tranexamic acid 250 mg with physiologic saline (TXA group), or physiologic saline (control group) and then followed by clamp drain for 2 hours. Postoperative blood loss was measured by three different methods as drainage volume, total hemoglobin loss and calculated total blood loss. Transfusion requirement and postoperative complications were recorded. All patients were screened for deep vein thrombosis and the functional outcomes were evaluated at 6 months after surgery. The mean postoperative drainage volume, total hemoglobin loss and calculated total blood loss in TXA group were 308.8 mL, 2.1 g/dL and 206.3 mL compared to 529.0 mL, 3.0 g/dL and 385.1 mL in the control group (P=0.0003, 0.0005 and <0.0001 respectively). Allogenic blood transfusion was needed for one patient (4.2%) in TXA group and for eight patients (33.3%) in the control group. Postoperative knee scores were not significantly different between groups. No deep vein thrombosis, infection or wound complication was detected in both groups. In this study, low dose intra-articular tranexamic acid injection combined with 2-hour clamping drain was effective for reducing postoperative blood loss and transfusion requirement in CAS-TKR without significant difference in postoperative complications or functional outcomes.

scholarly journals A non-randomized prospective study of the blood sparing effect of tranexamic acid in total knee replacement

2016 ◽  
Vol 3 (1) ◽  
pp. 12
Author(s):  
Anand Gupta ◽  
Ashok Nagla ◽  
Vinay Tantuway ◽  
Rishi Gupta ◽  
Vivek Patel ◽  
...  
Keyword(s):  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Subcutaneous Tissue ◽  
Skin Incision ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Total Knee

<p class="abstract"><strong>Background:</strong> Several techniques are available to minimize the likelihood of blood transfusion following total knee arthroplasty. Tranexamic acid, an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin has been reported to reduce intraoperative and postoperative blood loss in patients undergoing total hip and total knee arthroplasties with or without cement. The objective of this study was to assess the efficacy of antifibrinolytic treatment along with other measures like saline adrenaline infusion, no drain, no tourniquet and hypotensive anaesthesia in reducing perioperative blood loss during total knee replacement<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> Between January 2011 to January 2016,  seventy five consecutive patients who had given written informed consent, undergoing a TKR received tranexamic acid 15 mg/kg body weight intravenous 5 minutes before the skin incision and two doses afterwards (3 and 6 hours after the first dose respectively). TKR was performed in a routine fashion without tourniquet. The saline adrenaline (1:200000) was infiltrated into the skin subcutaneous tissue and capsule before skin incision. A routine closure was carried out without drain. Total blood loss including the hidden blood loss was calculated. All patients were monitored for anemia and postoperative thromboembolic complications.<strong></strong></p><p class="abstract"><strong>Results:</strong> The average total blood loss in study group is 433 ± 148 ml. This is much lesser than what other studies have reported. Mean reduction in hemoglobin levels (gm/dl) between preoperative and postoperative readings is 1.6 gm/dl. One patient had a postoperative DVT which was treated with rivaroxaban 20 mg OD for 6 weeks (oral anticoagulant)<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> Antifibrinolytic agents like tranexamic acid used along with other measures reported in this study produces a significant decrease in blood loss in patients undergoing total knee replacement<span lang="EN-IN">.</span></p>

scholarly journals Tranexamic Acid Reduces Total Blood Loss and Inflammatory Response in Computer-Assisted Navigation Total Knee Arthroplasty

2019 ◽  
Vol 2019 ◽  
pp. 1-7 ◽  
Author(s):  
Kuan-Ting Wu ◽  
Ka-Kit Siu ◽  
Jih-Yang Ko ◽  
Wen-Yi Chou ◽  
Shu-Jui Kuo ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Computer Assisted ◽  
Transfusion Rate ◽  
Total Blood ◽  
Perioperative Blood Loss ◽  
Total Knee ◽  
D Dimer

Introduction. Tranexamic acid (TXA) is an effective blood salvage agent that reduces perioperative blood loss in conventional total knee arthroplasty (TKA). As computer-assisted surgery for TKA (CAS-TKA) results in a lower perioperative blood loss than conventional TKA, the additional effect of blood conservation by TXA might be mitigated. This study aimed to evaluate the efficacy of TXA in CAS-TKA. Methods. We retrospectively reviewed 222 consecutive patients who underwent CAS-TKA. Intravenous TXA was administered in 103 patients (TXA group) at a dosage of 20 mg/kg 15 min before deflation of the tourniquet. The other 119 patients did not receive TXA (control group). Patient demographic data including age, gender, BMI, DM, and hypertension were collected. The primary outcomes were the estimated total blood loss (ETBL) and perioperative data, including tourniquet duration, preoperative and postoperative day 1 (POD1) and day 3 (POD3) serum D-dimer, CRP, hemoglobin (Hb), and hematocrit (Hct) levels. Secondary outcomes including transfusion rate and 90-day complications were recorded. Results. The ETBL was lower in the TXA group on both POD1 (404.34 ± 234.77 vs. 595.47 ± 279.04, p<0.001) and POD3 (761.39 ± 260.88 vs. 987.79 ± 326.58, p<0.001). The TXA group also demonstrated a lower level of CRP on POD1 (p=0.02) and lower levels of CRP and serum D-dimer on POD3 (p=0.008 and p<0.001). Consumption of fibrinogen was higher in the control group on both POD1 (p=0.013) and POD3 (p<0.001). Length of hospital stay was lower in the TXA group (5.42 ± 1.21 vs. 6.25 ± 1.49, p<0.001). The transfusion rate and perioperative complications were not significantly different between the two groups. Conclusion. Administration of TXA is not only effective in reducing perioperative blood loss and length of hospital stay but also exerts an anti-inflammatory effect following CAS-TKA without causing major complications.

scholarly journals Efficacy and safety of pre-operative single dose parenteral tranexamic acid in moderately anaemic parturients undergoing caesarean section

2017 ◽  
Vol 6 (8) ◽  
pp. 3423
Author(s):  
Robin Medhi ◽  
Sonika Bawri ◽  
Chaitra S.K. ◽  
Mansur Ahmed ◽  
Asmita Mishra
Keyword(s):  
Caesarean Section ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
P Value ◽  
Study Group ◽  
Total Blood ◽  
Moderate Anaemia

Background: Preoperative administration of Tranexamic acid (TXA) has been found to be effective in reducing the amount of blood loss following Caesarean section in low risk women. However, studies in high risk women such as women with anaemia, where blood loss needs to be minimised are scarce.Methods: An experimental case control study was conducted with a total of 174 patients with moderate anaemia undergoing CS in a teaching hospital. Study group consisting of 87 patients received pre-operative TXA 1g intravenously. Intra operative and up to 6hours postpartum blood loss was calculated in both the groups. Requirement of blood transfusions were noted. Data analysed using Graphpad Instat® 3 statistical software.Results: Present study showed statistically significant reduction in intraoperative and postoperative blood loss among patients who received TXA compared to control group. The blood loss from placental delivery till completion of the procedure was significantly lowered (304.02ml vs 393.36ml; p value <0.0001). Postoperative blood loss (from end of the procedure up to 6hrs postpartum) was 62.57ml in comparison to 85.40ml in control group (p value <0.0001). The total blood loss from the placental delivery up to 6 hours postpartum was significantly reduced in study group (366.59ml vs 478.76ml; p value <0.0001). There was significant reduction of blood transfusion in study group (RR: 0.20, 95% CI, 0.045-0.887), without immediate adverse effect on mothers and new-borns.Conclusions: Administration of TXA preoperatively causes significant decrease in blood loss and the need for blood transfusion in patients with moderate anaemia undergoing CS. 

scholarly journals Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Paphon Sa-ngasoongsong ◽  
Siwadol Wongsak ◽  
Noratep Kulachote ◽  
Pongsthorn Chanplakorn ◽  
Patarawan Woratanarat ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Predicting Factors ◽  
Total Knee ◽  
Low Bmi

Background.Recently, intra-articular tranexamic acid (IA-TXA) application has become a popular method for perioperative blood loss (PBL) reduction in total knee replacement (TKR). Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT) after IA-TXA.Materials and Methods.A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014). Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL), estimated total blood loss (ETBL), and drainage volume per kg (DV/kg). Excessive PBL was defined as PBL that exceeded 90th percentile.Results. From multivariate analysis, low preoperative hemoglobin (Hb) level and body mass index (BMI) were the significant predictors of postoperative BT (p<0.0001and 0.003, resp.). Excessive THL significant associated with preoperative Hb (p<0.0001). Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05all). Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001and 0.002, resp.).Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

Efficacy of repeated intravenous tranexamic acid in reducing perioperative bleeding of acetabular fractures

2021 ◽  
pp. 1-7
Author(s):  
Chen Xu ◽  
Min Wu ◽  
Zhaodong Wang ◽  
Yajun Liu ◽  
Pinghui Zhou ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Operative Time ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Acetabular Fractures ◽  
Control Group ◽  
Transfusion Rate ◽  
Total Blood ◽  
Thrombosis Rate

BACKGROUND: Application of tranexamic acid (TXA) in the treatment of acetabular fractures could reduce intraoperative and postoperative blood loss. OBJECTIVE: To investigate the effect of single and repeated intravenous infusion of TXA on blood loss of acetabular fractures. METHODS: 120 patients with acetabular fractures admitted to our hospital from January 2017 to September 2020 were retrospectively divided into three groups: Patients accepted 1g TXA at preoperative 30 minutes were defined as single TXA group (n = 40); Patients accepted 1g TXA at preoperative 30 minutes and 1g TXA at 3 hours after the start of surgery were defined as repeated TXA group (n = 40); Patients accepted normal saline at preoperative 30 minutes were defined as control group (n = 40). RESULTS: The total blood loss in single TXA group and repeated TXA group were significantly lower than control group, and the total blood loss in the repeated TXA group was significantly lower than single TXA group (P <  0.05). The hidden blood loss from surgery to postoperative 1 day in repeated TXA group was significantly lower than single TXA group and the control group(P <  0.05). No significant differences were observed in the operative time, postoperative transfusion rate and thrombosis rate among the three groups (P >  0.05). CONCLUSION: Repeated TXA is more recommended during acetabular fracture surgery since it can reduce the total blood loss without increasing the operative time, postoperative transfusion rate and thrombosis rate compared with single TXA.

scholarly journals Multimodal Peri-articular Injection with Tranexamic Acid can reduce postoperative blood loss versus Intravenous Tranexamic Acid in Total Knee Arthroplasty: A Randomized Controlled Trial

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hui-ming Peng ◽  
Wei Wang ◽  
Jin Lin ◽  
Xi-sheng Weng ◽  
Wen-wei Qian ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Blood Loss ◽  
Postoperative Blood Loss ◽  
Total Blood ◽  
Randomized Controlled ◽  
Hidden Blood Loss ◽  
Total Knee

Abstract Background Tranexamic acid (TXA) has shown significant reductions in blood loss and transfusion rates in total knee arthroplasty (TKA). However, the optimal administration route continues to be debated. The aim of this trial was to compare the effectiveness of intravenous (IV) versus peri-articular injection (PAI) application of tranexamic acid in patients undergoing total knee arthroplasty. Methods We conducted a randomized controlled, double-blinded study. A total of 93 patients undergoing primary unilateral TKA were randomly distributed between 2 groups: the IV group (47 cases; 1 g TXA IV) and the PAI group (46 cases; 1 g TXA injected peri-articularly). The amount of total and hidden blood loss (HBL), drainage, transfusion rate, hemoglobin and hematocrit drift, and complications were recorded. Results Peri-articular injection of TXA reduced total blood loss (P < 0.001) and HBL more than IV use of TXA (P < 0.001). No patients in either group received a transfusion. No symptomatic deep venous thrombosis or other severe complications occurred. Conclusion Peri-articular injection of TXA significantly reduced total blood loss and hidden blood loss to a greater degree than IV injection in total knee arthroplasty without reduction of drainage volume. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-16010270. Date of registration: December 27, 2016.

scholarly journals Reduction of blood loss after total knee arthroplasty by tranexamic acid

2020 ◽  
Vol 9 (2) ◽  
pp. 114-118
Author(s):  
Sashmit Sharma ◽  
Kiran Prasad Rijal ◽  
Tanup Prasai ◽  
Amit Poudel
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Postoperative Blood Loss ◽  
Control Group ◽  
Case Group ◽  
Operative Blood Loss ◽  
Total Knee

Background: Total knee arthroplasty is associated with significant peri-operative blood loss. Various studies have shown that the use of tranexamic acid reduces post-operative blood loss and need for allogeneic blood transfusion in total knee arthroplasty.  Objectives: To assess the effect of tranexamic acid in the reduction of the postoperative blood loss in total knee arthroplasty. Methodology: An analytical cross-sectional study was carried out in 14 patients who underwent primary total knee arthroplasty during the study period of 12 months at Kathmandu Medical College. Seven patients were allocated to the case group and received one gram (gm) of tranexamic acid thirty minutes prior to the incision and five hundred milligram (mg) orally three times a day till the drain was removed. Tranexamic acid was not given to the seven patients in control group. The haemoglobin of the patient was recorded on the day of surgery and the total amount of drain output was recorded on postoperative period until the drain was removed. Results: Out of 14 patients operated, it was found that the average amount of drain in the patients in case group was 628 ± 234 millilitre (ml) which was significantly lower than the control group 1028 ± 183  ml (p<0.05). Though there was a difference in the amount of drain output, there was no significant change in the postoperative haemoglobin level in both the groups (p = 0.381).  Conclusion: Tranexamic acid, an antifibrinolytic agent, can be effective to reduce blood loss in patients who undergo major surgeries like total knee arthroplasty.

scholarly journals Periarticular injection of tranexamic acid promotes early recovery of the range of knee motion after total knee arthroplasty

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901986469
Author(s):  
Hitoshi Hirose ◽  
Hiroyasu Ogawa ◽  
Kazu Matsumoto ◽  
Haruhiko Akiyama
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Early Recovery ◽  
Periarticular Injection ◽  
Maximum Flexion ◽  
Maximum Flexion Angle ◽  
Total Knee

Purpose: Tranexamic acid (TXA) is a commonly used compound that reduces postoperative blood loss. Periarticular injection of TXA is a recently reported procedure with some advantages such as cost-effectiveness and the ease of performance over an intravenous or topical administration. However, its association with functional recovery remains unclear. This study aimed to examine the effect of periarticular injection of TXA on early postoperative recovery of knee functionality after total knee arthroplasty (TKA). Methods: Eighty-four patients who underwent primary unilateral TKA from February 2013 to August 2016 were classified into two groups based on whether they received TXA injection (44 cases each in the TXA and control groups). Patients in the TXA group received periarticular injection of TXA (1000 mg) just prior to incision closure. Ten-meter walk test (s), pain visual analog scale, knee extension muscle force (N), range of motion (ROM) (maximum flexion angle, maximum extension angle, and motion arc), and blood loss (mL) were assessed. Results: The maximum flexion angle and maximal extension angle on postoperative day (POD) 4, POD7, POD10, and POD14 in the TXA group were significantly larger than those in the control group. The postoperative drained blood in the TXA group was significantly less than that of the control group (543.9 ± 464.3 mL and 814.9 ± 481.4 mL, respectively, p < 0.05). No significant difference was observed in the other parameters at any time point. Conclusion: Periarticular injection of TXA significantly promotes early recovery of knee ROM after TKA. Level of Evidence: Level IV, therapeutic case series.

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