scholarly journals Tranexamic acid use in simultaneous bilateral total knee arthroplasty : a comparison of intravenous and intra-articular applications, which is more effective?

2021 ◽  
Vol 87 (3) ◽  
pp. 479-486
Author(s):  
Alpaslan Öztürk ◽  
Yavuz Akalin ◽  
Nazan Çevik ◽  
Özgür Avcı ◽  
Oğuz Çetin ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Bilateral Total Knee Arthroplasty ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Total Knee

Patients applied with simultaneous bilateral total knee arthroplasty (SBTKA) with the administration of intravenous or intra-articular tranexamic acid (TXA) were compared in respect of blood loss and the need for allogenic blood transfusion. Of a total 53 patients applied with SBTKA, 32(60%) were administered intravenous TXA and 21(40%) intra-articular TXA. The patients were evaluated in respect of age, gender, height, weight, body mass index (BMI), body blood volume, preoperative and 1,2,3 and 4 days postoperative levels of hemoglobin (Hb) and hematocrit (Htc) and the change in Hb levels, estimated blood loss, mean actual blood loss, the need for allogenic blood transfusion (ABT) and the use or not of a drain. No difference was determined between the intravenous and intra-articular groups in respect of mean age, gender, height, weight, and body blood volume. No difference was determined between the groups in preoperative and postoperative mean Hb and Hct values, the reduction in mean Hb postoperatively, estimated blood loss, or the need for ABT. No deep vein thrombosis or pulmonary embolism was determined in any patient. In the application of SBTKA, TXA can be safely administered by the intravenous or intra-articular route to reduce the need for ABT. The results of this study determined no difference in efficacy between the routes of application. For patients with a risk of intravenous use, intra-articular application can be preferred.

scholarly journals Intra-articular tranexamic acid as an adjunct to intravenous tranexamic acid for simultaneous bilateral total knee arthroplasty: a randomized double-blind, placebo-controlled trial

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sachiyuki Tsukada ◽  
Kenji Kurosaka ◽  
Masahiro Nishino ◽  
Tetsuyuki Maeda ◽  
Yoshiharu Yonekawa ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
University Hospital ◽  
Allogenic Blood Transfusion ◽  
Allogenic Blood ◽  
Perioperative Blood Loss ◽  
Total Knee ◽  
Simultaneous Bilateral Tka

Abstract Background Intra-articular tranexamic acid (TXA) as an adjunct to intravenous TXA was reported to decrease perioperative blood loss during unilateral total knee arthroplasty (TKA). However, there have been no randomized controlled trials comparing intravenous versus combined intravenous and intra-articular TXA administration in patients undergoing simultaneous bilateral TKA. Methods We randomly assigned 77 patients with 154 involved knees undergoing simultaneous bilateral TKA to the intravenous TXA group (intra-articular placebo for each knee) or combined TXA group (1000 mg of intra-articular TXA for each knee) with 1:1 treatment allocation. In both groups, 1000 mg of TXA was given intravenously twice, just before surgery and 6 h after the initial administration. Other perioperative medications, surgical procedures, and blood management strategies were the same for all patients. The primary outcome was perioperative blood loss calculated from blood volume and change in hemoglobin from preoperative to postoperative day 3. Results Intention-to-treat analysis showed no statistically significant differences in perioperative blood loss until postoperative day 3 (1067 ± 403 mL in the intravenous TXA group vs. 997 ± 345 mL in the combined TXA group [95% CI, − 240 to 100 mL], P = 0.42). No patients required allogenic blood transfusion. The incidence of thrombotic events did not differ between groups (12% in the intravenous TXA group vs. 9% in the combined TXA group; P = 0.73). Conclusions The addition of intra-articular TXA did not reduce perioperative blood loss in patients undergoing simultaneous bilateral TKA compared with placebo. Trial registration University Hospital Medical Information Network UMIN000026137. Registered 14 February 2017.

Tranexamic Acid Effectively Reduces Blood Loss and Transfusion Rates during Simultaneous Bilateral Total Knee Arthroplasty

2017 ◽  
Vol 31 (03) ◽  
pp. 270-276 ◽  
Author(s):  
Hernan Prieto ◽  
Heather Vincent ◽  
Justin Deen ◽  
Dane Iams ◽  
Hari Parvataneni
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Estimated Blood Loss ◽  
Flexion Extension ◽  
Total Knee

AbstractTranexamic acid (TXA) can reduce blood loss and decrease transfusion rates after total knee arthroplasty (TKA). The purpose of our study was to evaluate the efficacy of TXA in a homogenous, consecutive cohort of patients undergoing simultaneous bilateral primary TKA. This was a retrospective study of 50 consecutive patients who underwent bilateral simultaneous primary TKA between 2011 and 2015. Of these, 20 patients received TXA and 30 patients did not receive TXA and served as the control group. Primary outcome measurements were intraoperative estimated blood loss, hemoglobin (Hb) and Hematocrit (Hct) levels on postoperative day (POD) 1 and POD2, and blood transfusion rates. Secondary outcomes included length of stay (LOS), knee flexion/extension range of motion (ROM), and postoperative complications. There was no difference between groups for preoperative Hb and Hct (all p > 0.05). The TXA group demonstrate higher Hb levels at POD1 (11.7 in TXA vs. 10.4 controls; p < 0.001) and POD2 (10.5 in TXA vs. 9.6 controls; p < 0.001), as well as higher Hct levels at POD1 (35.6 in TXA vs. 32.1 controls; p < 0.001) and POD2 (31.9 in TXA vs. 29.3 controls; p < 0.001). There was less percentage variation in Hb levels in the TXA group from preoperative to POD1 (17.7% in TXA vs. 25.7% controls; p < 0.0001) and POD2 (26.1% TXA vs. 31.8% controls; p = 0.019). Similarly, less percentage variation in Hct levels in the TXA group from presurgery to POD1 (17.0% TXA vs. 25.7% controls; p < 0.0001) and POD2 (25.0% TXA vs. 31.3% controls; p = 0.005). A total of 23.3% of patients in the control group required transfusions compared with no patients in the TXA (p = 0.044). There were no differences in LOS, knee ROM, or number of complications. No thromboembolic events occurred. TXA in bilateral simultaneous TKA effectively reduces blood loss, maintains postoperative Hb and Hct levels, and significantly decreases blood transfusion rates. The level of evidence is level III (therapeutic study).

scholarly journals Low blood transfusion rate after implementation of tranexamic acid for fast- track hip- and knee arthroplasty. An observational study of 5205 patients

2021 ◽  
Vol 87 (1) ◽  
pp. 9-16
Author(s):  
Yoeri Bemelmans ◽  
Emil Van Haaren ◽  
Bert Boonen ◽  
Roel Hendrickx ◽  
Martijn Schotanus
Keyword(s):  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Allogenic Blood Transfusion ◽  
Transfusion Rate ◽  
Allogenic Blood ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
Hip And Knee Arthroplasty

The purpose of this study was to retrospectively evaluate the efficacy of a tranexamic acid (TXA) perioperative protocol for primary hip- and knee arthroplasty, in terms of allogenic blood transfusion rates. A retrospective cohort study was conducted and included all primary hip and knee arthroplasty procedures in the period of 2014-2019. Patients who underwent surgery due to trauma or revision were excluded. A total amount of 5205 patients were eligible for inclusion. Two equal and weight depending doses of TXA were given, preoperative as an oral dose and intravenously at wound closure. The primary outcome was blood transfusion rate. Further analysis on patient characteristics (e.g. age, gender), blood loss, perioperative haemoglobin (Hb) levels and complication/readmission rate was performed. A total of 49 (0.9%) patients received perioperative allogenic blood transfusions. Mean age, distribution of gender, body-mass index, American Society of Anaesthesiologists score, duration of surgery, type of arthroplasty, estimated blood loss, perioperative Hb levels and length of stay were statistically significant different between transfused and not-transfused patients. The incidence of thromboembolic adverse events (e.g. deep vein thrombosis/lung embolism) was 0.5%. Low blood transfusion rate was found after implementation of a standardized perioperative TXA protocol for primary hip and knee arthroplasty.

scholarly journals Hemostatic effect of tourniquet combined with tranexamic acid in total knee arthroplasty: a network meta-analysis

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Yimin Zhang ◽  
Bao Lang ◽  
Guifeng Zhao ◽  
Fengming Wang
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Meta Analysis ◽  
Total Blood Loss ◽  
Total Blood ◽  
Study Results ◽  
Total Knee

Abstract Background There are various techniques to reduce blood loss in total knee arthroplasty (TKA), including the use of a tourniquet and tranexamic acid (TXA). In this study, we studied the combined effect of TXA with a tourniquet on blood loss in the setting of primary TKA. Methods Randomized controlled trials (RCTs) of nine treatment methods were included (placebo, intravenous [i.v.] TXA, topical TXA, i.v.-combined topical TXA, oral TXA, placebo + tourniquet, i.v. TXA +tourniquet, topical TXA + tourniquet, and i.v.-combined topical TXA + tourniquet). The patients were divided into eight groups according to the different treatment strategies, with 30 cases per group. The differences in the total blood volume, the number of patients transfused, the hemoglobin before and after the operation, and complications after the operation were compared. Results Totally 15 RCTs meeting our inclusion criteria were collected in this study. Compared with the placebo + tourniquet group, the i.v. TXA + tourniquet group displayed lower hemoglobin reduction value, pulmonary embolism (PE) incidence, total blood loss, and blood transfusion risk; the topical TXA + tourniquet group showed reduced PE incidence, total blood loss, and blood transfusion risk, and the i.v.-combined topical TXA and i.v.-combined topical TXA + tourniquet groups showed decreased total blood loss and lower blood transfusion risk. Retrospective clinical study results also demonstrated that the efficacy of i.v.-combined topical TXA was the best. Conclusions Our meta-analysis indicates that i.v.-combined topical TXA provides a low total blood loss without increasing the blood transfusion risk in patients undergoing total knee replacement surgery.

scholarly journals Retrospective comparative study of IV+ local tranexamic acid versus IV tranexamic acid only in primary total knee replacement

2021 ◽  
Vol 7 (2) ◽  
pp. 308
Author(s):  
Sanil G. Kamat ◽  
Rohan Dessai
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Blood Transfusions ◽  
Operative Outcomes ◽  
Total Knee ◽  
Retrospective Comparative Study ◽  
Group 1

<p class="abstract"><strong>Background: </strong>The study is to compare the immediate post-operative outcomes with use of intravenous (IV) tranexamic acid (TXA) versus IV and local TXA combination in primary unilateral total knee arthroplasty. Study comprised of 72 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and post op blood loss in drain, fall of haemoglobin levels and need of blood transfusion was recorded. The results were statistically compared. The mean blood loss fall in HB levels and need of blood transfusions revealed statistically significant differences.</p><p class="abstract"><strong>Methods:</strong> Total 72 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 (IV only): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet. Group 2 (IV + Local): 1 gm IV Tranexamic acid bolus 10 min before deflating the tourniquet and 1 gm Tranexamic Acid in 50 ml saline locally at the time of closure.</p><p class="abstract"><strong>Results: </strong>It was observed that higher post op blood loss, higher fall in haemoglobin (HB) levels and higher requirement of blood transfusions were associated with group 1 as compared to 2.</p><p class="abstract"><strong>Conclusions: </strong>The study inferred that the combination of local and systemic tranexamic acid was superior than systemic administration alone with lower post op blood loss, lower rates of blood transfusion and lower fall in haemoglobin levels without any added complications.</p>

scholarly journals Effect of Tranexamic Acid on Blood Loss and Blood Transfusion Reduction after Total Knee Arthroplasty

2016 ◽  
Vol 28 (3) ◽  
pp. 188-193 ◽  
Author(s):  
Young-Jun Seol ◽  
Jong-Keun Seon ◽  
Seung-Hun Lee ◽  
Cheng Jin ◽  
Jatin Prakash ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Knee Arthroplasty ◽  
Total Knee
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